Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients
medrxiv.org
medrxiv.org
From the abstract:
> In the HCQ group, 2.8% of the patients died within 7 days vs 4.6% in the no-HCQ group (3 vs 4 events, RR 0.61, 95% CI 0.13-2.89), and 27.4% and 24.1%, respectively, developed acute respiratory distress syndrome within 7 days (24 vs 23 events, RR 1.14, 95% CI 0.65-2.00).
The relative risks and confidence intervals are the important numbers here. For example, the relative risk for death is 0.61, meaning the observed risk of death was lower for patients treated with hydroxychloroquine -- but the confidence interval is 0.13 to 2.89, meaning the data is consistent with anything from the risk being much smaller to the risk being much larger. Since there were only 3 deaths in the treatment group and 4 deaths in the control group, it's very hard to draw precise conclusions about death rates.
I think we can interpret this result to mean that hydroxychloroquine doesn't have a miraculously large effect, but the evidence is weak. Other commenters are correct that large randomized trials will be more definitive.
(disclaimer: I am a statistician, not a doctor)
If your effect is small enough that you need a meta-analysis in the first place, that's a warning sign.
Some background: https://journals.plos.org/plosone/article?id=10.1371/journal... (with perhaps more approachable explanation here https://www.talyarkoni.org/blog/2016/06/11/the-great-minds-j... )
Obviously it's sometimes possible to do this right, but the reproducibiility crisis didn't appear out of nowhere; it's best to be wary of overly clever statistics; hard to know what you don't know.
Putting this all together is done in meta analysis which is complex and finds things in small studies that don't show up but it isn't trivial to do them.
Title of the paper could (with a tongue firmly in cheek) be called, "Weak evidence for effectiveness of hydroxychloroquine but our sample was likely too small for it to pass a T-test"
edit: clarified it a little
Even based just on this evidence, the case for HCQ looks very, very weak. The only positive report was riddled with caveats that could easily explain a false-positive, and other reports see next to no effect.
Note that it's perhaps not so interesting whether it has some effect; for this to really matter, it needs to be somewhat significant effect (in the real-world impact sense, not the statistically measurable sense). And even a small sample can reliably detect large effects; several studies have now not found such an effect; ergo: it doesn't exist.
If HCQ has any benefit whatsoever as applied once very sick, the benefit is likely too small to matter much in terms of mortality. And it's unlikely to be relevant whether it works beforehand; there's no way to make enough to give it to everyone which is what you'd need to do if you wanted to significantly impact the pandemic if HCQ were prophylactic.
It seems very unlikely at this point that HCQ is going to matter much in the course of the pandemic.
It would be irresponsible to choose an experimental design (like significance level) and then use wishy-washy language ("weak evidence") to work around it when the study criteria aren't met.
This would be more akin to the headline from the press release for the study from the university PR office.
I took that to mean they obviously weren't suggesting something so conversational as the actual title, but the takeaway is the same and shouldn't be a conclusion taken from the OP comment.
However you are correct that the medical community has decided to be conservative to reduce the likelihood people make decisions based on weak evidence. That may be the correct decision from a overall social welfare perspective. In that framework all we can say is "this experiment did not generate enough evidence to reject the null hypothesis".
"In the weighted analysis, 20.2% patients in the HCQ group were transferred to the ICU or died within 7 days vs 22.1% in the no-HCQ group (16 vs 21 events, relative risk [RR] 0.91, 95% CI 0.47-1.80)."
And...
"Eight patients receiving HCQ (9.5%) experienced electrocardiogram modifications requiring HCQ discontinuation."
Those ECG changes aren't generally observed just in people who have COVID-19; it's the drug that we know does that, doing that.
I'm curious as to the permanency of the damage.
Boosting unproven drugs is dangerous and irresponsible, and arguing that fact is not the same thing as arguing that the drug is ineffective.
That's incorrect. Absence of evidence is evidence of absence. It's just not proof of absence. See https://www.lesswrong.com/posts/mnS2WYLCGJP2kQkRn/absence-of...
I think the parent post is making an important and accurate point.
> "no evidence of efficacy" does not imply evidence of no efficacy, and in fact the uncertainty in this study is quite large. The sample size is small enough that it would be very hard for this study to detect the effect of hydroxychloroquine unless that effect is very, very large.
What you're saying might be correct but misses the point of the parent (and perhaps statistics) completely.
If the claim had been "no patients treated hydroxychloroquine recover", and the study found no patients that recovered, the argument would apply: there's no evidence that patients recover, which starts to suggest that indeed, patients do not recover.
But here we are interested in estimating the size of the effect, which can take any continuous value. The statistical result is that the relative risk of death is, with 95% confidence, somewhere between 0.13 and 2.89. You can't interpret that as evidence relative risk is exactly 1 (equal risk with or without the drug) -- if you could, you could also take it as evidence the relative risk is 1.2, or 2.7, or 0.75.
This experiment is so small that it had virtually no chance of ever being able to detect an effect on the probability of death (what statisticians call the "statistical power" of the experiment is only 10% whereas a well designed study should aim for power above 80%). Even if the drug cured 100% of people it was given to, a study this small would not be able to statistically conclude whether the drug works. Since the baseline death rate is only 4%, it takes fairly large samples to be able to detect any change. A 200 person experiment has basically no hope of being able to detect a difference in the death endpoint (there is a bit more hope for the more common ICU endpoint).
Yet we do not waste our time testing it.
To address the elephant in the room: yes, Trump did come out in favor of hydroxychloroquine, but his opinion on medical issues is literally meaningless noise in both the informational and auditory senses of the phrase. We certainly shouldn't be pursuing hydroxychloroquine because Trump said to, but there are other good reasons to at least investigate it.
For example, it's highly unlikely (roughly less than 2.5%) that HCQ reduces the onset of ARDS by half.
If it ultimately turns out that HCQ reduces the rate of death by 5%, we'd have to do a tremendously large trial to distinguish that effect from the control with any confidence that it's not actually killing 2% more people. Additionally, you'd have to consider that vs. the fact that it will kill some fraction of people who take it from its cardiac side effects, even if doctors are vigilant about discontinuing therapy when arhythmias are detected.
Typical trials are designed to have a large enough sample size that they will be able to detect any effect big enough to be clinically important.
Here, they just went with the sample size they had available (understandably), which was so small that only a very large effect could be clearly established. It is completely wrong to interpret the lack of a statistically significant effect with this small sample size as showing that the drug doesn't work.
Consider the result regarding transfer to ICU or death:
20.2% patients in the HCQ group were transferred to the ICU
or died within 7 days vs 22.1% in the no-HCQ group (16 vs 21
events, relative risk [RR] 0.91, 95% CI 0.47-1.80)
Again, note also that more patients on HCQ were diagnosed with ARDS, so if you pick a different measure, you get the opposite result.
Adding to this, there are at least two reasonably sized ongoing trials of HCQ with appropriate randomization and blinding in North America alone (I believe there are a number of others elsewhere). I would encourage everyone to withhold judgement until either they post results, or a similarly reliable alternative data source appears.
Target size of 3000 (https://clinicaltrials.gov/ct2/show/NCT04308668).
Target size of 400 (https://clinicaltrials.gov/ct2/show/NCT04329923).
(It was also mostly junk science of course too)
> For example, it's highly unlikely (roughly less than 2.5%) that HCQ reduces the onset of ARDS by half.
is not one that can be justified by frequentist statistics such as those used in the article. We can't make probabilistic claims like that unless we go Bayesian.
Well-designed drug trials typically plan in advance to have the sample size necessary to detect an effect of clinical significance. If, say, a 20% reduction in ARDS would be valuable, you would work out what sample size you'd need to reliably detect such a reduction. In this case, we simply don't have the sample size to conclude much of anything, because the confidence intervals include what I (as a non-physician, admittedly) see as a pretty wide range of clinically meaningful effect sizes, and we can't distinguish between them.
In frequentist statistics, the true population parameter is fixed, not random, so the claim "the relative risk will be less 0.65 2.5% of the time" has no meaning. The 95% claim is that if we repeatedly sample new data, 95% of the time we will generate a confidence interval covering the true parameter; but that does not say anything about the individual confidence interval in this specific case, about which we have no probability claim. Indeed, it's not clear what a 95% chance would mean for a specific interval, since probability in frequentist statistics is defined in terms of long-run probabilities over repeated samples of data.
But the impulse to interpret confidence intervals in a Bayesian way is common, since it's the question we want confidence intervals to answer. You can find a lot of academic papers arguing about this as a sign of the inadequacy of frequentist statistics.
This article is a preprint and has not been certified by peer review
The reason they aren't doing large randomised controlled trials is because the hydroxychloroquine itself is killing people, and it's unethical to continue.
People have said they'd rather have malaria than take it, and that should tell you something. The side-effects for hydroxychloroquine include death, which is not immediately obvious from reading HN.
Doctors aren't just making this up and ignoring evidence, the drug is bad, and not effective for covid-19
I call shenanigans.
There's a reason it's not licensed for viruses, and why only a tiny number of people take it, and there's a reason why wide scale trials are being cancelled. There isn't a huge anti-hydroxychloroquine conspiracy here
Doctors are already saying that it's definitely no magic bullet, but they debate whether it is effective at a certain stage of illness.
What I don't understand is why we're focusing so much on this specific drug when there are some great antivirals out thee that have a more effective theoretical mechanism of action. (eg Remdesivir)
[1] https://www.fiercebiotech.com/biotech/gilead-clinical-data-h...
The US government could simply seize the patent if Gilead acted in a manner against the public good.
Incentivizing people to not do productive things like develop drugs seems like a really bad idea.
[1] https://ccbjournal.com/articles/benchmark-metrics-pharma-com... [2] https://www.investopedia.com/ask/answers/060115/how-much-dru...
That's absolutely not what would happen. I was chatting with a family member who used to work in biotech/pharma and posed the question what would happen if Remdesivir is found to have efficacy against covid-19. What they said is basically there would be licensing done immediately to other pharma companies which would run manufacturing in parallel with what Gilead is doing. Gilead will be getting profits from each pharma company that gets a license. I am unsure why the lead time is so long, however it may be that the company does not want to create a huge supply of a drug that may not be effective. But this is very interesting, the pentagon is getting lots of remdesivir for troops so there must be some info that leadership has about its success rate: https://qz.com/1834939/how-the-military-secured-experimental...
So the subpopulation needing remdesivir is probably less than 5% of the positive cases (or 1250 of the 25,000 who tested positive here). BTW, the county population is 900,000.
...so a targeted application of anti-virals is definitely worthwhile.
And how funny is it (at least to me) that this is only because Trump came down on one side initially. If he had come out saying exactly the opposite, that HCQ was bad and we should be skeptical, everyone hoping it doesn’t work now would be looking for the 10 person studies saying it totally works and defending its use.
It’s almost beyond reason how hyper partisan this specific issue is.
If you listen to virologist podcast, TWIV, they talk about the effectiveness of HCQ. They aren't all "it's amazing!", but they do not make the claim that it doesn't work.
For some issues there's plenty of partisan hackery to go around, but in this instance there is clearly one person to blame for turning this into a partisan issue. Politicians should not be offering their opinions on drug efficacy, full stop.
Can we expect preliminary data from this trial before the primary completion date?
* Have had close contact with a known positive individual within the past 4 days (but not have any symptoms themselves yet).
* Have developed symptoms (and tested positive) within the past 4 days.
Technically that's not really a prophylaxis, but it's early enough that it's practically the same thing. It's also more representative of how we would be likely to employ the medication in the real world. (Also I don't see how it would be ethical to intentionally expose people, and waiting for people to be inadvertently exposed seems impractical for a number of reasons).
Edit: Whoops. I had slightly confused the smaller PATCH trial (https://clinicaltrials.gov/ct2/show/NCT04329923) and the larger University of Minnesota one (https://clinicaltrials.gov/ct2/show/NCT04308668). It looks like the PATCH trial is indeed only testing actual prophylaxis in healthcare workers, and specifies a two month period for each participant in the trial.
What's the mechanism supposed to be here? If it suppresses replication of the virus, shouldn't that be effective up to close to the point of death - once replication is slowed enough, viral load should fall off, and recovery should happen?
https://www.youtube.com/watch?v=U7F1cnWup9M&list=PLQ_IRFkDIn...
If you can moderate the immune system's reaction you can prevent significant damage. HCQ is useful for this type of immuno-suppression.
Here's a pre-print of an article from a few years back which talks about HCQ and cytokine storms:
Scott W. Canna, Edward M. Behrens. Making Sense of the Cytokine Storm: a conceptual framework for understanding, diagnosing and treating hemophagocytic syndromes. Pediatric Clinics of North America [Preprint]. April 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368378/
Published article link: https://dx.doi.org/10.1016%2Fj.pcl.2012.03.002
It's decently likely from what I've been reading that there might end up being effective pharmaceuticals for each stage, but that they'll be totally different from one another: maybe HCQ and antivirals like remdesivir or favipiravir early, and maybe immune-modulators like tocilizumab or even corticosteroids in this second phase. But again, the devil will be in the details, as it looks like HCQ doesn't work late, and steroids or other immune modulators might be actively harmful in that first stage when the virus is still surging.
As for mechanism: nobody is really sure. HCQ does have some immune-modulating effects (that's what makes it useful for lupus), but there's also speculation that it might have some effect on the interaction between the ACE2 receptor and the coronavirus spike protein, and so somehow inhibit viral entry (see, e.g., https://www.nature.com/articles/s41421-020-0156-0).
The "most promising" study I saw early on was this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102549/ - which seemed to suggest that the combo eliminated the viral load in 3-5 days.
The only followup study I've found was this one: https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v... - that urged caution with the combo because of a possibility of increased heart failure.
Obviously, that's a very small study with
The opportunistic bacterial infection is separate (although you’re correct that it has a role here)
> Worryingly, significant risks are identified for combination users of HCQ+AZM even in the short-term as proposed for COVID19 management, with a 15-20% increased risk of angina/chest pain and heart failure, and a two-fold risk of cardiovascular mortality in the first month of treatment.
Based on that, azithromycin would appear to be a decidedly bad choice of antibiotic to use in conjunction with HCQ. Luckily there are many others available.
Derek Lowe has a recent and much more detailed analysis of all of this. (https://blogs.sciencemag.org/pipeline/archives/2020/04/11/th...)
HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).........be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov
That's not an endorsement?
Joe Biden has a real chance to be one of the biggest game changers in the history of this country. The Democratic party has moved mountains in their support of them - Thank You! Hopefully he will take office IMMEDIATELY. PEOPLE ARE LOSING FAITH, MOVE FAST, and GOD BLESS EVERYONE! @US_DNC @JoeBidenPrez @POTUS @IowaElections
The base rate probability for an arbitrary drug to treat a disease with no treatments is probably extremely low, < 1%. There are thousands of drugs; at most a few treat COVID-19. Suggesting that any single drug has a significant chance of a positive effect puts it well ahead of the pack.
By contrast, the base rate for a former Senator doing an okay job with the Presidency is probably in the range 20-80%. Suggesting that Biden would do as well as any other former Senator (may or may not) is not an endorsement, but suggesting he would do much better than the base rate is definitely an endorsement.
"I sure as hell think we ought to give it a try."
"one of the biggest game-changers in the history of medicine"
"I want people to live and I’m seeing people dying and I’m seeing people who will die without it,"
These statements are just the tip of the iceberg when it comes to endorsements by Trump.
She got that impression from somewhere, but certainly not from any of the studies I've read, leaving the conservative news sphere as the likely source. Whoever is making the exaggerations, they're egregious.
which may have influenced her and the POTUS
Novartis has committed to donate up to 130 million doses which should cover a fair bit.
1. HCQ has been used for many decades
2. The side effects are generally known
3. It may have a positive impact on COVID-19, and it may not.
4. Nobody is suggesting long term high doses for anyone, COVID patients or otherwise.
5. If people are severe patients of COVID-19, this should certainly be tried as a treatment as long as the patient (or immediate family) is briefed on the potential side effects. The alternative, potential death, makes this a worthy discussion for a doctor/patient to have, with families being allowed to err on the side of right-to-try. HCQ is cheap, available, and has been used for decades.
The fact that "no evidence HCQ works!!" has 200 points of upvotes and counting when the sample size for this study is 181 patients only just shows how high the temperature has become.
Everyone just calm down. As capnrefsmmat has eloquently pointed out, "absence of evidence" does not mean "evidence of absence".
If you enjoy the thrill of debates for debates sake, here are other potential topics for you: Whether masks are effective, condoms, seatbelts, helmets, or even parachutes[0]:
[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
Favourite part:
Results We were unable to identify any randomised controlled trials of parachute intervention.
Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
2. They are known but they are by no means mild. A trial in Brazil just got aborted due to severe heart problems.
3. So does almost everything. If that's your threshold for taking a drug then I have a lot of homeopathic remedies to sell you!
4. Actually the doses given for COVID are often higher. Not sure what long-term has to do with anything.
5. That assumes that the risk of side effects is zero. It's not. Also, there is an opportunity cost to taking HCQ instead of something else.
I totally agree with you that we should do proper trials on this and see what happens. But right now there is zero evidence that it actually works, and some (admittedly low-quality) evidence that it might not.
Not just higher. The original article (the one out of China) that mentioned that there might be some positive effects reportedly suggested using doses that were a whopping 5 times higher than the usually prescribed amounts: 500mg/day vs the usual 100mg/day.
What more, the same article put forward that the drug was considered generally safe and without any potentially troublesome side effects. That raised more than a few eyebrows amongst the medical staff who knew the drug.
I would add: HCQ is most effective at the onset of symptoms. It stops the virus from replicating, it does not repair cell damage. Also, it must be used with zinc together, since HCQ opens the cells to absorb zinc and zinc must be present.
You can have significant results with as little as 10 random samples. People are mad because this is getting pushed as a treatment for COVID-19. The only correct response is: "We do not have evidence that this a treatment for COVID-19."
As more research is done we can update our knowledge on this, but instead you talk about the "experts" like they you know more than they do. Typical anti-academic rhetoric.
Let's call a spade a spade. Trump, not 'some people'. Trump's medical training amounts to what, exactly? He heard that a drug has some beneficial effects on a similar disease and is all aboard, and HE is the one "some people say it's an amazing drug", "it can't hurt you" (except when it can), "I'm seeing people who will die without it" (based on what, exactly?). Oh, "and I directly profit from it".
People aren't screaming that HCQ "shouldn't be used", but that a President shouldn't be using his position (and complete lack of medical training) to be promising things that are at best unproven, and at worst, factually incorrect.
What? Why not try literally anything and everything else that has not been proven?
Some thoughts:
My understanding is this is a powerful alkaloid. My experience has been that similar compounds can help combat inflammation. They also can work to help kill infection at times.
By the time people with Covid19 need oxygen, inflammation doesn't seem to be the primary problem. So I wouldn't think it would be particularly helpful at that point.
Ventilators get prescribed in part on the assumption that inflammation in the lungs is a major impediment to getting sufficient oxygen. Ventilators are failing at a shockingly high rate, with a death rate up around 80% or so. Some doctors are moving away from ventilators because the death rate is so high.
I spoke recently with a researcher who suggested impaired vasodilation was a possible explanation for the reports of low oxygen combined with a surprising lack of pneumonia and inflammation in some cases and that makes a lot of sense to me. The mechanism causing low oxygen does not appear to be the obvious answer of "lung inflammation and pneumonia."
That doesn't mean this drug can't play a meaningful role at some stage. It mostly means it's not the magic bullet solution for advanced cases that they were hoping for.
This in no way surprises me because the things it actually treats do not appear to be the cause of low oxygen in advanced covid19 cases.
https://twitter.com/scottgottliebmd/status/12500696095810314...
Glad to see some doctors are working on that angle. (crosses fingers, hopes for better treatments soon)
A better headline would say something like: "study finds that HCQ is not a miracle cure for already-hospitalized covid-19 patients".
I don't see anything in the study that discredits HCQ as a potential treatment, and therefore it makes sense to keep researching.
A sample size of 20 is sufficient to satisfy a .05 statistical significance threshold that hydrochloroquine had even the slightest positive effect. In this population, it did not.
All therapeutic drugs are developed using in vitro and pre-clinical (non human animal) treatment groups no bigger than 20. When a well controlled and randomized study comparng two groups that are each four times larger than 20, we have a VERY strong indication that this drug delivers not only too little effect to be a useful treatment for COVID-19, but it very likely delivered absolutely NO EFFECT AT ALL in hospitalized patients. Don't expect any reputable physician or scientist to dismiss this evidence.
This is very bad news for the prospect for treating patients who need it using this drug -- those people who are likeliest to die or endure lasting harm. The other 80% of positive patients don't need any therapy except time.
A total of 63 patients were included with 32 in the hydroxychloroquine arm.
Hydroxychloroquine administration was associated with a need for escalation of respiratory support level compared to those that did not receive hydroxychloroquine at 5 days (p=0.013). The same findings were observed in a baseline-matched subgroup analysis. Absolute lymphocyte change in the hydroxychloroquine group was no different than supportive care alone (p=0.413).
Hydroxychloroquine use trended towards worsening neutrophil-to-lymphocyte ratio compared to supportive care alone (+9.59 vs +1.58, p=0.51) as well as a higher risk for intubation (p=0.051).
p=0.413
p=0.51
> Hydroxychloroquine administration was associated with a need for escalation of respiratory support level compared to those that did not receive hydroxychloroquine at 5 days (p=0.013).
> p = 0.013
Yes, exactly, p=0.413 corresponds to a coin toss, or as the authors of the paper put it "no different".
The p=0.51 figure seems to be a typo in the abstract. If you read the content of the paper, it says
> The hydroxychloroquine group also had a strong but not statistically significant trend towards worsening NLR (p=0.051).
So I believe they just accidentally moved the decimal place, and they are correctly avoiding calling the result statistically significant, but it is close.
[1] French ~50 patient study that tried Control, Hydroxychloroquine, and Hydroxychloroquine + Azithromycin combo: https://www.mediterranee-infection.com/hydroxychloroquine-an...
That's my main take-away at this point. I have seen enough reports saying it worked, and enough saying it didn't that I believe the answer is probably somewhere in the middle.
My understanding is the best guess for how it works is by keeping the viral infection from becoming serious enough to require hospitalization. Similar to how proper treatment of wounds early on keeps them from getting to the gangrene stage where you need amputation.
Unfortunately, politics. So the Left wants it to be completely no use at all, and the Right wants it to be a miracle drug. Most of the population really probably just wants effective treatments if they end up getting sick.
The left wants Trump to be wrong about everything, so wants this it to fail.
The right wants Trump to be right about everything, so wants it to work.
I understand wanting to chastise Trump for being exaggerated and reckless about an unproven treatment, but wanting it not to work? That can't be true.
Eh? Even if it did turn out to work, it would still have been an unfounded claim for Trump to claim it did without evidence, and a stupid and dangerous thing to do. That's what 'unfounded' means.
(I think this is quite irrational, but that's your answer.)
I didn't think testing drugs before giving them to people was considered "irrational" as you state, but I guess that is where we are now.
The efficacy picture on these drugs is quite confusing, and it's not out of the question that they will turn out to be crucially useful. Giving up on them without further investigation doesn't seem wise at this point.
Beyond that, sometimes being a leader means giving people hope, even if that might involve shading things. Trump may not be an Adama, but I do think he's pretty good at making people feel better, or at least distracting them from their troubles. And right now, that probably is saving lives.
Giving up on them without further investigation doesn't seem wise at this point.
I don't disagree with these ideas on the surface, but they seem largely strawmen-style arguments. I'm not convinced a significant number of people somehow "hate" hydroxychloroquine or are against research solely on the basis that Trump mentioned it.
Would you say it's irrational to oppose that idea? I mean it's not been proven to not work, so you gotta try anything you can, right? And he's giving people hope.
We were (and largely still are) dealing with a lot of unknowns. As far as I'm concerned, everything is on the table, as a possible improvement.
It could be! I mean, his ideas presumably don't come from taking a random issue of the National Enquirer at face value, but he has or had a widely reported close relationship with the publisher, so it seems entirely plausible he might have been influenced by, say, David Pecker's opinions.
Trump isn't much to watch, but he does end up being right on some of his wacky-sounding calls more than I would have thought. I wouldn't bet my money against him.
And yet on multiple occasions he's been seen tweeting and announcing policies in lockstep with segments on Fox News opinion shows.
At the time, who could say if his opinion was based on anything, he would be proven right, anyone would take it seriously, etc.? The public and media don't know these things.
I'm having a really hard time trying to abide by that rule in this case.
I will suggest that you may have cause and effect backwards in at least some cases. Some people may be bitterly opposed to him because of nonsense like this rather than thinking this is nonsense because they bitterly oppose him.
He has an obligation to look out for his people. This is not how you do that. This is the opposite of responsible behavior.
I'm quite upset about the whole thing, not because I'm anti Trump, but because it's a global pandemic. This isn't run of the mill, business as usual bullshit where political things like cronyism and glad handing make any sense whatsoever.
If you look at the charts of per-capita deaths in various countries, there's not much of a pattern, in terms of places we'd think of as having "good" government and/or public health versus "bad". Belgium, for example, is the worst right now (or among them), and many European countries are doing quite badly.
My personal suspicion is that in a case like this, there isn't really that much difference in in-the-moment governing across countries.
When I took archery in college, I was the only one in class who could consistently hit the bullseye. I also practiced up to two hours a day.
A classmate who didn't practice, who had terrible form and was holding the bow all wrong and who couldn't manage to hit the target at all snidely informed me one day that it was all luck. He completely dismissed the idea that either proper form or practice made any difference whatsoever.
I know that in complicated situations, it can be quite hard to determine what actually worked and why. This is why humanity has practices like deferring to experts with a solid track record of success as evidence that they know whereof they speak, even if it basically looks like stuff and nonsense to most of the rest of us because we don't all have a PhD in that subject and a zillion years of experience like them.
In general, I'm not particularly a fan of Trump, but I don't buy gibe that he's a lucky idiot. Nobody's luck is that good.
As to whether he's helped or hurt in this crisis, I hope someone evenhanded like Ken Burns will pick it apart later.
IMHO he was right to lean on the FDA to find out if its effective. Since it's already available, it would make sense for doctors to try it, but most are not trained in doing controlled trials so the results are all over the map.
Most noticable to me is that when referring to this issue/drug, the media always points out that HCQ is not approved for covid-19. They neglect to point out that there is no approved treatment at all. It seems like an attempt to make Trump look reckless and irresponsible.
Objectivity and politics dont mix.
Otherwise anyone can just claim anything whenever they want without any proof whatsoever.
We don't even hear about four-dimensional chess or "draining the swamp" anymore.
Source: married to a physician who usually has a 1,200 patient panel, with a diversity of conditions; said physician spouse was at one point recruited to run an RCT for a drug company and did a lot of work to prepare and then pulled out because spouse figured out they'd not be allowed the latitude to improve the study design, and felt that the study design was slanted inappropriately to supporting the efficacy of the drug (it was not being compared to standard of care but instead to a demonstrably inferior treatment, a previous standard of care).
Yeah, objectivity and politics don't mix. There are people who do RCTs and do them well, and they're not just random doctors kind of scattering drugs among their patient panel.
Absolutely. It wasn't a criticism, just the way things are. For example, one doctor is claiming HCQ + zinc + antibiotic has treated over 700 covid-19 patients without a single death. I think it would be appropriate for someone to audit his records to see if that's true (was it even covid? or just some cold going around in his area?). If another doctor wanted to replicate his alleged success, I could easily see them using a slightly different protocol (skipping the zinc, using a different antibiotic, changing when or how much to administer, etc) and then claiming he's wrong when it doesn't work for them. That's just how a lot of people behave unless they've been trained otherwise.
Questioning the wisdom of that, given how little we knew, is seen as a partisan attack on Trump.
The initial study indicating HCQ was effective was recently withdrawn by the publisher for failing to meet their journal's publishing standards [1]. And for good reason, as the study conveniently dropped patients that deteriorated from their final numbers. None of the follow up studies I have seen (including the one in the OP) have shown anywhere near the same level of effectiveness.
> Unfortunately, politics. So the Left wants it to be completely no use at all
That is such a twisted, uncharitable interpretation of the situation that I have to wonder if it is intentional. Do you really think "the Left" would rather have the drug be completely ineffective so the entire planet has to keep this lockdown going? Really?
I guarantee you every single fucking person on this planet, left, right, or center, would love to have an effective drug against this virus right now.
The primary point I've seen made by "the Left" on this matter is the President of the United States should not be tweeting out unproven drug combinations until their efficacy has been demonstrated by clinical trials. Particularly when: 1) such drug combinations can potentially increase the risk of heart failure [2], and 2) people rushing out to buy these drugs has constrained the supply for patients who actually need it to treat their existing illnesses.
Unfortunately, politics, indeed. The world has gone insane when the position of "don't taken unproven drugs with risky side effects without medical supervision" is construed as a "leftist position" instead of COMMON SENSE.
[1] https://www.isac.world/news-and-publications/official-isac-s...
[2] https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v...
For example, their "control" group were just arbitrarily-chosen patients treated at different hospitals, not people treated in the same hospital as where the study was conducted.
If there’s a risk of a supply run, it would definitely not last very long. For many people there’s alternatives for treating arthritis and lupus.
If it’s shown even to improve the patient’s outcome by even just 10% or more (as this study suggests), every country should be ramping up production of it right now instead of letting it be politicized.
Unlike off-patent prescription drugs.
"Covid-19 Could Bring Generic Drug Manufacturing Back to the U.S., Analyst Writes"
https://www.barrons.com/articles/covid-19-could-bring-generi...
You're dropping the context of the hard decisions nations and governments actually deal in day to day, year to year when it comes to budgets. That's why not a single country had a proper stockpile of N95 masks for a pandemic like this. That isn't an exaggeration: literally not one nation had enough of a stockpile for this scenario, that includes South Korea, Japan, China.
To say that nobody thought to do it is outlandish. As one example Congress set aside funds in 2006 to stockpile 100 million N95 masks. That's not strange, as many people were aware of the need to maintain such a stockpile. There is a big difference between being aware of the need, proposing plans and spending for it, and actually getting billions of dollars on a recurring basis to maintain the necessary proper stockpile perpetually with no event to push it with (yeah but we had a flu pandemic in 1957! try selling that premise). That's the actual reality of budgets and governments.
It's expensive to maintain a persistent minimum stockpile of 1 billion non-expired N95 masks to cover the US population and the demand the US has seen. If it's a year-long pandemic, a billion masks isn't enough. You need several billion masks in that scenario. Coming out of the great recession, that is a very hard budget decision for all nations. And the fact is, most nations can't afford to do it at all. The easy retort of course is to say, well, look at the damage from this virus compared to that cost for masks. That's purely hindsight spouting that tries to pretend a comprehensive reality doesn't exist and that people who make budgets don't have to deal with difficult decisions every single year (while not factoring in every possible bad scenario every time they make a budget).
And let's not pretend it's enough to stockpile masks, regarding spending allocations. If we're doing hindsight fantasy, let's be correct about it. You need to constantly maintain a lot of other gear and training for a pandemic, costing large sums of money. In an ideal scenario a nation the size of the US should probably have over a million ventilators stockpiled, just in case. We should probably maintain 2x or 3x the ICU capacity we have, on a persistent basis and at a large cost.
This isn't an argument against being more prepared. Of course every nation should have a vast magical stockpile of N95 masks that never depletes, even the ~140 poor nations of the world that can't afford to do it. The point is, it's difficult to convince any nation to do it at the required persistent scale, and most can't afford to do it regardless.
I think there is an alternative solution, though: Rather than maintaining a gigantic stockpile large enough to last a multi-year pandemic, it might be more efficient to maintain a modest stockpile sufficient for the breakout phase along with ready-to-deploy crash production capacity. This might be significantly cheaper.
This means that we need to ensure that we have the capacity to 100x, 1000x, 10,000x production--whatever is modeled to be enough to meet ongoing demand during a pandemic--within the time bought by drawing down the strategic reserve.
We don't need to maintain and refresh a complete stockpile of finished goods, or even a complete stockpile of production capacity (suitable factory floor space, meltblown nonwoven fabric equipment, etc.). We just need to know where such things exist that can be quickly directed to the desired use either with cooperation from the owner or with the DPA, how much exists naturally, and only if there is a deficit, to maintain a stockpile sufficient in combination with those identified supplies: Government-owned sterile factory floor space, for example, or spare production lines for meltblown nonwoven fabric.
We can even enlist private companies to maintain the stockpile for us. It makes way more sense to just subsidize e.g. 3M to have lots of extra meltblown nonwoven fabric production capacity. They are in the business, they maintain and operate the machinery and have the know-how and commercial connections to produce and distribute the material. They will have the capability to quickly respond to demand spikes if the capital requirements for increased production capacity already exist thanks to Uncle Sam's foresight.
Finally, what is maybe even more important than stockpiles or production capacity subsidies is the organization this exercise entails (knowing who makes what critical parts in the supply chain, where they are, what their production capacity is and how quickly it can grow, etc.), which gives an ability to rapidly marshal resources and eliminate inefficiencies to surge production as quickly as possible.
Sure in the long run it may be relatively easy to manufacture enough HCQ. But right now stocks are running extremely low because people are trying to use it for COVID without any scientific basis.
1: It’s probably the bullwhip effect and hysteresis in the supply chain but that’s speculation on my part.
Besides, by requiring a prescription you’re negating the ability for people to hoard. And a single pallet of HCQ is enough to treat thousands of people.
I really hope you look into how easy to manufacture and abundant HCQ is. It’s important to combat media scaremongering.
You mean the country that, more than a month ago, restricted exports of many drugs and chemicals used to make drugs (the so-called Active Pharmaceutical Ingredients). Your local end of the pharmaceutical supply chain can't deliver drugs that can't be made anymore.
Also, this study does NOT suggest that patient outcome is improved by 10% or more. Not in any way. Fewer patients died within the timeframe of this study, but more patients on the drug experienced ARDS; not to mention that 9 patients had to be removed from the study due to cardiac effects of the drug.
In general, that doesn't mean we should simply abandon all attempts to de-politicize it. In fact, it means just the opposite - we should put aside any political aspects and focus on objective data.
As of the last time I talked to her a couple days ago, my mother still hasn't been able to fill her hydroxychloroquine prescription that she has used to treat lupus for over 30 years. The alternative medications are steroids such as prednisone, which have previously caused dangerous side effects. Due to the useless panic buying, she's is now at severe risk of a bad autoimmune reaction if anything activates her immune system (even from a mild cold; covid-19 would be fatal).
> every country should be ramping up production of it right now instead of letting it be politicized
Yes, they should, but before that happens while supplies are limited, there are people that need the drug for well-established reasons.
The world largely moved past quinine for battling malaria quite a while ago. In fact, chloroquine is all but banned in my country now.
Guardian article - https://www.theguardian.com/world/2020/mar/27/vital-drug-peo... .
It cites someone from Lupus UK. Their page at http://www.lupusuk.org.uk/uk-azathioprine-supply/ says "we have received reports from a number of people with lupus who have been unable to fulfil their prescription of azathioprine" and that "stocks are in the process of being replenished and should be available in the UK in mid-April".
Comment from an HN'er:
"For several weeks my mother hasn't been able to fill her regular prescription for hydroxychloroquine that has been an important part of managing her lupus for >30 years." - https://news.ycombinator.com/item?id=22793293
It may be that the answer to these questions is "yes," but that answer seems to be being assumed right now.
Since the questions #1 and #2 can be answered both "yes" and "no", with equal merit, I suggest that perhaps they are not useful questions.
That is, not every pharmacy in every country is out, and sometimes a pharmacy is out of a medicine. If that's what you mean by "universal" and "local shortage before" then you're being absurd.
Bear in mind that I was answering beaner's question, not making some broader statement.
Did you really mean "universal" to mean every pharmacy in the world, and did you really mean "Have there been shortages" to include a single pharmacy somewhere running out? No. But how am I supposed to know what you do mean?
Your questions did not seem informed by the information in the links I presented, which suggests a different sort of bias.
So while you could doubt such a story for other reasons, the causal linkage is being made explicitly in at least some instances.
The original article has no such problem. Yet the person I replied to could be interpreted as "wait, maybe its still good!". My comment makes zero sense as a reply to the original article.
This is mostly a technical problem of how comment trees that get extremely heavy having no natural way to divide themselves. Sometimes we prune them, and when we do that, we try to do it in a non-lossy way.
Giving someone who has had essentially a heart attack (by definition COVID patients have elevated troponin which is the marker we use to assess if one has had a heart attack) is probably a bad idea so my question is: why would we celebrate a drug that has massive cardiac adverse effects as a side effect? Don't get me wrong I understand that there are drugs that are even worse. Cyclosporine is the first line immunosuppresant for kidney transplant. Do you know what one of the most common adverse effects of cyclosporine is? Kidney failure. But we don't know what is causing the kidney failure in a kidney transplant (rejection vs adverse effect) so we have to biopsy. Kidney biopsy is a very invasive procedure, FYI. My point is, maybe waiting for double blind placebo research here is the best case. Also, I made this exact same point on here a month ago and people told that they would take my dose if it came to that and at this point I will say go ahead.
[1] https://www.ncbi.nlm.nih.gov/pubmed/32169400
[2] https://www.nejm.org/doi/full/10.1056/NEJMoa2004500 [3] https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.0... [4] https://jamanetwork.com/journals/jamacardiology/fullarticle/...
So, for a younger (< 60) otherwise healthy person whose chance of death with covid is less than 1%, it would seem ill advised to take this medication at the onset of symptoms, unless the the disease itself causes similar or higher rates of heart damage.
The HCQ doesn't seem remotely merited based on its potential side effects unless you are in a higher risk factor for the disease, and of course even then, it's only merited it's actually efficacious (which it's seeming so far it isn't).
My hypothesis is that it's not going to be hydroxychloroquine that will be the miracle drug. There are better "hypothetical" alternatives that aren't getting as much mainstream attention but have a more realistic potential for working.
Correct, which is why I used the expression "ill advised". The advice in this case being that of a doctor.
There are so many sick people and it’s a cheap drug and only takes a week Or 2 to see if it works.
Can someone please just do a Really large trial, like, 2 weeks ago so we can put this to bed one way or the other.
So here we all are, hanging by the edge of our seats, waiting for definitive proof that HCQ does not help in fighting COVID-19 and we keep getting these half-assed reports, seemingly more aimed at pushing a narrative than to present (or eliminate) an option in a fight.
One of the latest examples is the account of Rita Wilson (wife of Tom Hanks) who survived what seems like a difficult case of COVID-19 and shared her experience with the media: she felt very tired, extremely achy, uncomfortable, didn't want to be touched, on the ninth day her fever climbed up to 102 and she had chills like she'd "never had before" (her words), she lost her sense of taste and smell. Then she was given chloroquine, her fever broke (it's not clear how long after). She goes on to warn against the "extreme" (her word) side-effects she attributes to chloroquine: she was completely nauseous, she had vertigo, she could not walk and her muscles felt very weak. She then concludes that although her fever broke after been given chloroquine, she doesn't know if it helped or if it was just time, which is fair. What do you imagine the headline for that story should be? Well, to save you the trouble, most read like this Rita Wilson warns against "extreme" side-effects of chloroquine.
Are HCQ/CQ effective? We're still sitting here like idiots not knowing. If they are, should they be taken carelessly? Definitely not, we already got that, thanks, but that is not the point. We can't afford to have an "all or nothing" mindset with these drugs as we did with masks. Simply proclaiming that HCQ is useless because it is shown not to reduce viral load is just the best way to pass on some other ways it might be helping. If it is shown to have other palliative effects that actually help patients in their fight, such as reducing inflammation or helping cope with high fever long enough for your immune system to do the job, it's not nothing. It's information. It's an option.
This was a targeted study looking at a specific circumstance. The situation was "all adults in 4 French hospitals with documented SARS-CoV-2 pneumonia and requiring oxygen ≥ 2 L/min"
So, adults who were not on oxygen are not included in the study. How does it pertain to them? That's not covered by this.
It reads like it's saying people who are in bad shape and on ventilators did not have a positive impact by Hydroxychloroquine.
This still leaves open questions like, can the use of Hydroxychloroquine lower the rate of needing to get on a ventilator.
I look forward to someone reproducing this study and looking into the other areas.
These numbers simply aren't enough to make a determination one way or the other. On mortality, the 95% confidence interval allows for a range of HCQ reducing death rates by 87% up to it increasing death rates by 2.9x.
There's also the fact that study makes it less likely that pre-hospitalization HCQ will have any effect either. Applying a Bayesian analysis here, it's now likelier that the true ground truth is simply that HCQ doesn't do anything to COVID-19 at all, not necessarily that it works only in a narrow early window. HCQ has severe side effects too, that require close monitoring and can be fatal. If it's not clearly doing good then it definitely shouldn't be being given to COVID-19 patients.
Personally, my hopes are more on remdesivir and favipiravir, both of which are actual antivirals (HCQ is not) and thus were always more promising. HCQ was never the most promising drug candidate, and the only reason we're even talking about it as much as we are is that, for whatever random reason, that's the one Trump heard about first and then fixated on.
I'd agree that we really don't have any evidence that giving it to hospitalized patients helps at all. Most antivirals have to be taken at the early stages of an infection.
The best looking treatment for people seriously ill with Covid-19 right now seems to be IL-6 inhibitors. That won't stop you from getting sick but might let you avoid intubation.
We'll see with the U of Minnesota trial, which attempts to use it as post-exposure prophylaxis. Data (hopefully) will tell us.
On favipiravir, the data on the Chinese study wasn't exceptional, but wasn't that bad either. Perhaps the Japanese phase 3 study will be more enlightening.
https://docs.google.com/document/d/1O6Cls-Oz2ZAgJuyDbnICEGjM...
Patients who get their treatment from doctors less fraudulent than the authors of this study almost certainly see better outcomes.
All the while HCQ remained unproven for Covid use, while people trying it got hurt by cardiac side- effects (and one couple in a prominent incident mistakenly took different chemicals with a similar name), and patients with other conditions ran out of HCQ due to shortages.
Maybe HCQ will be part of the standard of care for Covid- 19 in the future, but it’s seeming less and less likely. Meanwhile it’s definitely not a miracle cure, so the frenzied advocacy and adoption of this medicine will turn out to have been a bizarre story.
(I wrote this up here https://twitter.com/firasd/status/1250125344469708801)
I still can't say if he's a low hanging troll [1] or if he's just so far above the pack that everybody else is braining wrong. That's also his motto... he likes to discuss disruption and paradigm shift in his classes and talks about how every past paradigm was considered gold standard and only people breaking the mold advanced the state of the art.
[0] unsurprisingly Musk is also very fond of wide stats to justify his AutoPilot ~feature
[1] his lab specializes in repurposing well studied compounds for new diseases.. seems like leveraging past efforts to get success (if I go full paranoia :)
I wish medias would do broader panels to discuss varied POVs rather than one ~icon.
From a medical practice standpoint, you have a widely-available drug with well-known side effects that can be administered in a medical setting with low risk, and potential life-saving upside. When the research is early but potentially promising, it's not irrational to administer in cases where the side effects should be well-tolerated, even if later research shows no or low benefit.
The problem arises from self-administration without medical supervision, or with inadequate medical supervision.
Even when doctors were using HCQ before the politicians and random outsiders picked up on it, there were other drugs in the mix that they were also considering (Lopinavir, Remdesivir, etc). Incidentally Remdesivir trials have also come out lately seeming pretty weak. But there is still nowhere near the level of frenzy around Remdesivir as there has been around HCQ to the extent of advocacy at White House press briefings, international diplomatic incidents... it's beginning to seem like a very strange mass hallucination.
Can you name some prominent members of this cult and their statements that match this framing? Serious question. I don't think anyone really matches that description. Pretty much everyone horrified at the cloroquine boosterism was horrified because it was irresponsible and dangerous, not because they had strong feelings about the drug itself.
To clarify a bit: it's certainly not the position of the opposing party as a whole, but those I saw who were vehemently opposed to it were ideologically motivated.
It's not playing god, it's just making rational decisions in times of scarcity. That's something humans do constantly, no god necessary.
> This note addresses in more detail the relationship between our guidance and those patients who are elderly or who have disabilities. It emphasises that neither age nor disability are in themselves relevant criteria for making decisions about treatment.
This follows on from widespread (and perhaps misleading) reporting about a tool. This tool has NHS branding, but it doesn't appear to have come from NHS_England+Improvement. http://prod-upp-image-read.ft.com/765d3430-7a57-11ea-af44-da...
And why are we expecting a mechanism with hydroxychloroquine against this virus when essentially no small molecule therapies are effective against viruses in general?
And it might keep you from getting malaria while you have COVID19.
take it with a grain of salt but https://www.snopes.com/fact-check/zelenko-669-coronavirus-pa...
The original study that set off this flap ran for a period of 6 days. I don't know that 6 days is long enough for significant accumulation. Beyond that, unless someone has published something significant that I haven't seen, any hypothesis on the drug's effect on coronavirus is pure speculation.
I think the people have a right to know about cloroquine, since it became such a political point. But n=181 is not that small.
Beyond that, we do have the ability to perform small sample studies (cf. Student) and decide whether we’re headed in the right direction. Are we in a lull in statistics where we can’t even use statistics to guide future research?
from the article:
"We used data collected from routine care of all adults in 4 French hospitals with documented SARS-CoV-2 pneumonia and requiring oxygen ≥ 2 L/min to emulate a target trial aimed at assessing the effectiveness of HCQ at 600 mg/day...
This study included 181 patients with SARS-CoV-2 pneumonia; 84 received HCQ within 48 hours of admission (HCQ group) and 97 did not (no-HCQ group).
The median age of patients was 60 years ..."
"...[Patients were from] four French tertiary care centres providing care to patients with COVID-19 pneumonia. Adult patients were eligible in this study if they were aged between 18 years and 80 years, had PCR-confirmed SARS-CoV-2 infection, and required oxygen by mask or nasal prongs (corresponding to a WHO progression score of 5)."
"Among the 181 patients eligible for analysis, 84 received HCQ within 48 hours of admission and 97 did not (although 8 of them did receive HCQ later on)."
So, first of all, these patients were infected with Covid-19 _days_ prior and now had progressed to pneumonia. The up to two-day delay in the administration of HCQ after admittance to the study is disheartening.
I am surprised that, despite the experimentors selecting an elderly, pneumonic, oxygen-dependent cohort in advanced stages of the disease, these patients did as well as they did. Its a credit to the human body.
But timing is everything...
Once a Covid-19 patient has developed pneumonia, it is too late for hydroxychloroquine to affect the Covid-19 virus' replication process significantly. The patient's body is saturated with the virus.
In a patient who has developed pneumonia the disease has progressed to a second phase wherein the virus and other opportunistic pathogens (e.g., bacteria) attack the lungs and other tissue. Antibiotics may help at this point. But it is quite clear that the patients in this study arrived too late to gain any benefit from hydroxychloroquine which, when coupled with zinc sulfate, slows or halts viral replication _early_ in the disease, delays or halts the virus' progress and allows the body time to develop an immunological response to the virus.
The study's conclusion states explicitly that " These results ... do not support the use of HCQ in patients hospitalised for a documented SARS-CoV-2 pneumonia."
So, the trick is to treat _early_ with HCQ+zinc sulfate+azithromycin.
There have been a variety of studies and reports, both for and against, the use of hydroxychloroquine. Is there any reason this particular study is so highly upvoted? Or is this just an attempt to dunk on Trump for suggesting the drug showed promise?
If anything this study shows (albeit with small numbers) that HCQ doesn't make things worse.
But I have a feeling HCQ will be found to be effective. Big pharma have a lot of $$$ to make from their vaccine though.
The original studies that showed promise used combinations of Chloroquine, Azithromycin, and or zinc, and there is a speculated pathway by which these drugs interact to interfere with COVID replication. This study only looked at HCQ.
This kind of partisan, childlike pettiness is dangerous to all of us - what if Chloroquine works but we overlooked it because a couple shitty papers told us what we wanted to hear?
Was it appropriate to tweet about? Debatable. It is a presidents job to keep his people hopeful when possible, and this drug cocktail was in multiple (admittedly not perfect) papers at the time of the tweet. People need to be more objective when evaluating statements made by the president. That doesn't mean you have to like him.
Indeed, if that person had come up and said "there's a lot of promising treatments, such as ..." or "the experts are telling us that some studies involving [x, y, z] are showing some positive signs" or something of that ilk, nobody would have cared. Instead, the person multiple times touted something that is to date unproved. People find that irresponsible for a number of reasons, not least of which that there are legitimate users who need this and it's now in short supply.
So what people are protesting is someone not waiting for medical science and just causing noise.
Like many things, this person could have handled this all more responsibly.
"Very promising early results".
>https://www.google.com/search?q=trump+tweet+chloroquine&prmd...
"Have a real chance to be one of the biggest game changers"
Meanwhile the media response has been universally lamenting that a president would "tell people" [he didn't] to take this drug. How many outlets jumped on the single chloroquine phosphate overdose as proof of the president's responsibility? I encourage you to search "Trump" and "chloroquine" and find me a single headline that doesn't tear into Trump.
Like most people, your views have been warped by headlines and op-eds being touted as "news."
The fact that the president acts like a child doesn't mean our news should too. The petty editorialization of the daily briefings are an excellent example - the media's job in such a case is to be an objective first source - not to force their point of view through adversarial headlines that change every 5 seconds and "fact checking" only his alleged untruths. But this is where the majority of Americans get their news. It's shameful.
Edit: hell, look at this absolutely ridiculous headline at the top of the CNN "fact check" page: "Fact check: Trump denies saying another thing he said and makes more false claims at coronavirus briefing"
What kind of headline is that? Is anyone competent left at CNN? The media no longer deserves the soft power it wields. They lost that privilege when they strayed so far from any semblance of objectivity.
and
"Hopefully both will be used immediately. PEOPLE ARE DYING, MOVE FAST"
Both seem pretty ridiculous when we don't even know if its effective at all, let alone "one of the biggest game changers".
What else do you think the words "hopefully" and "real chance" are here to communicate?
What do you think "move fast" means? Administer the cure to everyone, or figure out if it works?
This was a clearly promising avenue and as the head of the executive this is one of the few things that the man has done right. This vitriol is pure, irrational bias.
What he did instead lacked context or information necessary to mass communicate. There's a way to communicate it and it wasn't this.
And you want to tell me that from his tweet you already know he didn't get this information from so called experts? How exactly does this tweet indicate otherwise?
>What he did instead lacked context or information necessary to mass communicate. There's a way to communicate it and it wasn't this
Welcome to the new normal, where politicians communicate via tweet. I agree that it is inappropriate but this particular example is just being used to project the usual anger onto him with multiple plausible but ultimately inappropriate rationalizations. There was, again, nothing inappropriate about a passing mention of a safe, cheap, promising drug. He could have done the same in the middle of a speech for similar effect.
Besides, what did you expect him to do, cite the relevant studies on Twitter? Sure, ideally he would, but let's not pretend that more than, say, .01 percent of the population is even capable of reading studies...
This is a shitty hill to die on.
Given his experts wouldn't validate it after ... yeah, probably.
> I agree that it is inappropriate but
Then what's the argument here? We both agree it's inappropriate. Just as I do when any other politician misuses it.
> Besides, what did you expect him to do, cite the relevant studies on Twitter?
No. I'd expect him to wait until there's something worth disseminating.
> This is a shitty hill to die on.
Who's dying on what hill here?
No-one wants it to fail. However, right now there's no reason to think that it is useful, and the sooner there's a definitive answer either way the better. Certainly, no-one should be taking it outside trials right now, and the ambiguity (and unreasonable hope stoked by high-profile idiots) is causing people to take it, often without medical supervision. This will kill people.
Probably cause he is lazy and more interested in selling and promoting himself than he is actually solving problems.
This guy knows the scientific method, I assume. he knows that something needs to be observable and replicated. Instead, he is asking us to trust his brilliance on something where the side effect might be death and blindness??
https://www.peakprosperity.com/about/
He doesn't seem to have many biomedical or pharmaceutical qualifications for pronouncing on what treatments may or may not work?
Edit: Apparently he has a PhD in neurotoxicty (specifically "Acrylamide neurotoxicity: effect on neuronal growth cones and axonal fast transport") which does bolster his credentials.
His PhD is in Neurotoxicology. Of all the things Martenson has been wrong about over the years, this particular event is a bit more in his wheelhouse than the economics or energy topics he typically covers.
"Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098036/)
Hey, it can't hurt and it might help. China has had one of the best recoveries from the pandemic.
Because TCM is - charitably - pseudoscience. Many of its remedies involve grinding up endangered animals into concoctions that have no plausible mechanism of treating the thing they're meant to treat.
> I've had anecdotal experience that it's helpful for milder coronavirus symptoms.
I have anecdotal experience that my microsorium musifolium plant has been effective in preventing coronavirus infection in my household. Unfortunately, just like your statement, this doesn't qualify as evidence and shouldn't be used to make public health decisions.
Regardless, let's wade in…
1. That's not's a study. That's not a metareview. That's a puff piece by people who have a strong, strong self-interest in promoting TCM, because they want to keep their department chairs.
2. Oh heck, I'll just quote the entire last paragraph:
"The safety of TCM in the treatment of emerging coronavirus diseases was not included in the observation on SARS patients. It was reported that some herbs used in TCM contain nephrotoxins and mutagens, while the toxicological features of the most of Chinese herbal medicines remain to be fully understood. Furthermore, herbs used in TCM can mimic, or magnify, or oppose the effect of conventional medicines. Thus, the safety of TCM used in treatment of emerging coronavirus infections should be carefully evaluated. It is particularly important to avoid toxicity or interfere with the efficacy of conventional treatment caused by herb-drug interaction."
So, in conclusion, we don't know if this works, and this stuff may be toxic, and it may have drug interactions, and oh by the way there's no quality control on this so you have no idea what's in the medications.
Might as well recommend acupuncture and getting your chakras aligned, couldn't hurt! (Probably less of a chance it hurting than taking a wild dose of unregulated herbal supplements.)
Indeed, it might help and it couldn't hurt.
"(Probably less of a chance it hurting than taking a wild dose of unregulated herbal supplements.)"
Or possibly a known drug with no real evidence of efficacy and a long list of known side effects?
Oh, and by the way, "That's a puff piece by people who have a strong, strong self-interest in promoting TCM, because they want to keep their department chairs," is both an hominem and describes all academic publications.
I'm taking the HQZ cocktail at first diagnosis even if I have to doctor shop.
Well hydroxychoroquine is only useful before ventilators are needed (it attacks the full lungs) and is actually detrimental - we know that - after by its nature.
What kind of bad science is this study where you actually push patients through a known dangerous path to try to prove the non efficiency of a potential treatment.
I’m worried that this has totally left the realm of science and is just pure politics... there is no evidence for a ‘magic window’ for HCQ in COVID-19 treatment, or any solid evidence of a positive role.
Secondly, having supplemental oxygen is not the same as being on a ventilator. I imagine most hospitalized COVID patients need oxygen (otherwise, they could be managed at home).
I hope we all avoid making comments (or even accepting comments) about medicine without either critical, independent study or background knowledge.