Comment by walterbell | Hacker News Reader

Comment by walterbell | Hacker News Reader

How about thanking or crediting the many independent doctors and scientists (https://zenodo.org/record/3873178) who identified the issues in Lancet's publication? Even Apple credits/pays independent researchers for finding weaknesses in Apple code.

Will countries now revert national health policy changes that were based on this questionable study? What about the families of patients who were denied early HCQ treatment based on this study? Who is liable for their denial of treatment?

James Todaro, May 29th, https://www.medicineuncensored.com/a-study-out-of-thin-air

> Misinformation is bad. Misinformation in medicine is worse. Misinformation from a prestigious medical journal is the worst. Herein is a detailed look at the controversial Lancet study that resulted in the World Health Organization ending worldwide clinical trials on hydroxychloroquine in order to focus on patented therapeutics.

Guardian, June 3rd, https://www.theguardian.com/world/2020/jun/03/covid-19-surgi...

> The very serious concerns being raised about the validity of the papers by Mehra et al need to be recognised and actioned urgently, and ought to bring about serious reflection on whether the quality of editorial and peer review during the pandemic has been adequate. Scientific publication must above all be rigorous and honest. In an emergency, these values are needed more than ever.

James Todaro helped to bring this questionable study to light—his website (https://www.medicineuncensored.com/) and compilation of HCQ studies (https://docs.google.com/document/d/1O6Cls-Oz2ZAgJuyDbnICEGjM...) may be of interest.

The WHO already restarted studies involving hydroxychloroquine.

>> Who is liable for their denial of treatment?

Doctors base their treatments on the best information they have at hand. In many cases, that information turns out to be faulty.

This retraction does not mean the HCQ works against COVID-19, only that this particular study is no proof that it does not work.

Hydroxychloroquine does not repair damaged cells, but it does stop the virus from replicating (especially when used with Zinc)

There are five scientific studies demonstrating this for outpatient use.

https://academic.oup.com/aje/advance-article/doi/10.1093/aje...

Come back, zinc!

Since this is being repeated multiple times, quoting benmaraschino:

One of these "studies" is a 2-page Google Doc with no real data. Another is the discredited Raoult study, which is under investigation by the journal [1]. Another study cited is also by Raoult's team. The Brazil study (ref. 29) doesn't seem to have passed peer review (yet?) and has severe methodological flaws. Like the Raoult studies, the Brazil study was not randomized, but makes no attempt to control for confounding by indication or self-selection, such as with propensity score matching or similar methods commonly used in observational studies. The last study cited isn't a study, but an article from a local news station.

I believe Hydroxychroloquine is used as a prophylaxis in India and possibly other countries. Have there been any studies on that?

The death toll (CFR) in India is suspiciously lower than in the European states. Could it be because they're using Hydroxychroloquine more freely [0]? Though, that hasn't been without controversy [1].

[0] https://medicalxpress.com/news/2020-05-india-hydroxychloroqu...

[1] https://science.thewire.in/health/covid-19-indian-council-of...

> The death toll (CFR) in India is suspiciously lower than in the European states

There are too many other, far more plausible, reasons why the death toll in India looks lower:

* Population pyramid - far fewer people aged 70+ as a percentage of the population means a far lower CFR

* Hotter weather which slows the spread of coronaviruses massively

* More sunlight means less vitamin-D deficiency (which seems to worsen infections)

* Low amount of travel to/from initial seeding spots means closing borders was effective (Wuhan, northern Italy, Alps)

And that is without casting any aspersions about causes of death being attributed correctly.

I came across this:

>According to the ICMR study published in the Indian Journal of Medical Research (IJMR), consumption of four or more maintenance doses was associated with a significant decline (>80%) in the risk of Covid-19 infection among the ‘participants’. The study also found that there was no significant association between HCQ and adverse drug reactions.

https://health.economictimes.indiatimes.com/news/pharma/why-...

Link to the preliminary paper http://www.ijmr.org.in/preprintarticle.asp?id=285520

We haven't gone from "BLOCK" to "ALLOW". Instead, we're back to "DUNNO".

https://en.wikipedia.org/wiki/Phases_of_clinical_research

So "dunno" is not a good enough reason to allow use of potentially damaging drugs. So we're still at "block".

Pretty much. Evidence-based medicine doesn't take its cues from Cave Johnson and just spitball stuff when people's lives are at stake. Plenty of promising drugs have horrible side effects, and it takes a lot of careful work to make sure they can be used safely to treat people. Thalidomide would be an excellent example of such a drug, which can cause excessive clotting and severe birth defects but also treats leprosy and certain cancers.

https://en.wikipedia.org/wiki/Thalidomide

I personally do not like drugs, but as far drugs goes Hydroxychloroquine is quite safe.

Hydroxychloroquine has been used since 1958 by millions of people. It is relatively safely (as much as any drug is safe) used for Malaria, Lupus and Arthritis. Some Lupus users have used it for decades.

The CDC on their web site state it is safe for young, old and pregnant.

https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/hydroxyc...

It's safe for people with those conditions, we don't know if it's safe for people in respiratory distress.

Take thalidomide for example. Great drug for treating nausea, but not great when that person is also pregnant. By not studying it in this group, it resulted in many people born with birth defects.

First that page shows a maximum daily dosage of 400mg/7 (weekly dosage) in adults. What's being used in covid patients is 800mg/day for the first day [1].

Can you point to any studies that shows the safety of hydroxycholorquine in people with respiratory distress or infection?

Can you show any studies that hyrdoxychlorquine is safe when the blood oxygen level drops below certain level often seen in covid patients?

Can I point you to here which shows all the potentially dangerous side effects of hydroxychloroquine?

[1] https://www.pdr.net/drug-summary/Plaquenil-hydroxychloroquin...

Interesting aspect is the following:

> Hydroxychloroquine prolongs the QT interval. Use hydroxychloroquine with caution in patients with conditions that may increase the risk of QT prolongation including congenital long QT syndrome, bradycardia, AV block, heart failure, stress-related cardiomyopathy, myocardial infarction, stroke, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances. Females, geriatric patients, patients with sleep deprivation, pheochromocytoma, sickle cell disease, hypothyroidism, hyperparathyroidism, hypothermia, systemic inflammation (e.g., human immunodeficiency virus (HIV) infection, fever, and some autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus (SLE), and celiac disease) and patients undergoing apheresis procedures (e.g., plasmapheresis [plasma exchange], cytapheresis) may also be at increased risk for QT prolongation.

Covid has been know to cause ill health too. Rather than ban anything with any risk a calculated judgement might be better.

So "dunno" is a good enough reason to allow people to suffer from potentially damaging COVID-19? There is a tradeoff whenever you default to "block", especially when there are no other good treatments. You are preventing people from searching the solution space.

A treatment needs to be safe and effective. So far the studies are unclear about the effectiveness, and also unclear about the safety. The retraction of one study doesn't mean it becomes safe or effective overnight.

And despite what people are saying, there are some nasty side effects for people with cardiovascular issues.

It's worth noting that infants have died with accidental exposure.

https://www.pdr.net/drug-summary/Plaquenil-hydroxychloroquin...

No one’s preventing properly designed and carefully run clinical trialS of COVID-19 treatments using HCQ. What doctors shouldn’t do is administer potentially life threatening drugs to sick patients based on rumor and speculation without any consideration. Such doctors are basically running badly designed, unsanctioned, unsafe experiments on people who’s ability to consent to the experimentation is compromised in any one of a number of ways, like being sedated and on a ventilator. Institutional review boards exist for a reason.

https://en.wikipedia.org/wiki/Institutional_review_board

The university of Minnesota has a clinical trial out showing no early benefit of HCQ treatment.

> The university of Minnesota has a clinical trial out showing no early benefit of HCQ treatment.

They have yet to publish the results on whether it benefits patients during the early onset of symptoms. [1]

Is hydroxychloroquine paired with zinc in the two studies? That has been the central claim of people supporting hydroxychloroquine this entire time and so far I've yet to see them used together in an early treatment / preventative study in the US (perhaps they've done so in Europe or China?).

[1] "A separate U trial is examining whether it benefits patients after early onset of symptoms, but results haven’t been published."

https://www.startribune.com/anti-malaria-drug-in-u-of-m-tria...

5 studies show it is effective for outpatients.

https://academic.oup.com/aje/advance-article/doi/10.1093/aje...

Since this is being repeated multiple times, quoting benmaraschino:

One of these "studies" is a 2-page Google Doc with no real data. Another is the discredited Raoult study, which is under investigation by the journal [1]. Another study cited is also by Raoult's team. The Brazil study (ref. 29) doesn't seem to have passed peer review (yet?) and has severe methodological flaws. Like the Raoult studies, the Brazil study was not randomized, but makes no attempt to control for confounding by indication or self-selection, such as with propensity score matching or similar methods commonly used in observational studies. The last study cited isn't a study, but an article from a local news station.

The Minnesota study shows that hydroxychloroquine does not prevent covid19 infection when taken after exposure.

This is a useful result, but it's not what we've really been wondering. The question of whether HCQ, possibly in combination with antibiotics or zinc and administered early in the infection, reduces the likelihood of getting a serious case.

The Minnesota study has some methodological issues, as well as not enough patients, that made it impossible to draw conclusions about this.

Hopefully, future RCT studies will illuminate this as well. Unless the Lancet paper has poisoned the source of candidates for the study enough that it will be impossible to recruit patients.

Try May 24th,

https://statmodeling.stat.columbia.edu/2020/05/24/doubts-abo...

Please don't fall for this. An article over at ScienceMag [1] states,

> ...James Watson, a statistician at Mahidol who on 28 May published an open letter to the journal and the study’s co-authors, signed by more than 200 clinicians and researchers, that calls for the release of Surgisphere’s hospital-level data, an independent validation of the results, and publication of the peer review comments that led to the Lancet publication.

This blogger's article is dated May 29.

Given that the underlying theme of this blog is "everyone's lying to you about covid19, it's actually not that big of a deal", I doubt James Todaro was as instrumental in The Lancet's retraction as the letter from 200 other researchers the day before.

It will be quite bad if it turns out that the WHO reacted to a study published in The Lancet that turns out to be fraudulent or grossly erroneous. We don't need to make the situation even worse by lending undue credit to other sources of disinformation.

[1]: https://www.sciencemag.org/news/2020/06/mysterious-company-s...

Todaro and others have been collating HCQ studies for weeks, as visible on Twitter. It's not a competition for credit, except against misleading studies. You can review the Google doc above, which is more than a month old. It contains a list of HCQ studies which include components likely to increase success: early treatment in time to slow viral replication with a combination of HCQ and zinc.

These successful HCQ studies, full of reports of lives saved, are worthy of attention.

Man, I'd love to argue with you on this. I'd love to do a decent job of pointing out that you're moving the discussion away from this potentially fraudulent paper published by The Lancet and towards the broader argument over HCQ. I'd love to spend the time to comprehensively review some dude's Google Doc that, at a random sampling, appears to contain non-peer-reviewed preprints and observational studies from discredited authors and not a single one of the much better studies that are critical of HCQ. I'd like to ask you why you're so readily willing to trust this particular treatment of this subject given the complete lack of contraindicating evidence.

But, I'm completely exhausted.

Between arguing against racists and arguing against bad politics during a global health epidemic and trying to catch and counter some of the relentless stream of disinformation on this and so many other subjects -- and all without any intervention at all from any of the social media platforms that enable all of this, including HN -- I'm tired, and discouraged, and dispirited.

I need to go away for a while. I hope someone else has the time and energy to curb stomp random dude's 25 page Google Doc minutes before someone else cites 25 pages of different BS.

No matter how hard you pout about it some people just won't share your enlightenment. so frustrating, isn't it? Almost as if others have as much right to their own worldview as you do yours. Even if you really think they're wrong.

Perhaps your exhaustion stems from defending a position, rather than seeking knowledge?

There are well-intentioned and capable people who have done their due diligence and ended up on different sides of this topic. What's interesting about this particular "social media" discussion are the real world consequences and incompatibility of some positions.

If the list of possible scenarios includes death, and people have invested the time to reach informed conclusions in consultation with their doctors, perhaps their choices can be respected.

I haven't heard the phrase "curb stomp" used in science before. That type of emotional language would seem to me to indicate a wish to defend a certain position, rather than evaluate evidence independently and accept an answer of "we don't know with certainty yet" if things seem inconclusive.

This is just one of many studies which has not found medical benefits for hydroxycholoroquine.

https://rheumatology.medicinematters.com/covid-19/hydroxychl...

No medical benefit ... in the treatment of covid-19.

its very possible the study can be wrong and HCQ still isn't an effective treatment, not sure you should read this news as an endorsement

Interesting timing given what’s going on in the world. This would have got more coverage 2 weeks ago.

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