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Comment by 52-6F-62 | Hacker News Reader

As far as I understood, the distaste for the support of the drug in the context of Covid-19 was that it hasn’t been proven to be the “miracle cure” some people have touted it to be.

Said touting was causing shortages at pharmacies where people like you who require the drug were not able to get access to it suddenly because of hordes of “supporters” buying up entire stocks.

Not because of who pushes it. It’s the consequences of uninformed broadcasting like calling it a final cure that have people shook.

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That’s not what is going on. News broadcasters are denouncing it as dangerous, and we can’t talk about it. Social media is banning videos by actual doctors.

A drug with a 10-50% success rate will still save a lot of lives.

This drug already saves millions of lives. My life is much better on it then before. It’s already reached miracle cure status. Question is, will it do it again.

    Cases and deaths averted. It is estimated that a cumulative 1.2 billion fewer malaria cases and 6.2 million fewer malaria deaths occurred globally between 2001 and 2015

https://apps.who.int/iris/bitstream/handle/10665/200018/9789...

> News broadcasters are denouncing it as dangerous

It is dangerous. Proper dosage and monitoring are necessary to guard against risk of QT prolongation and retinopathy. It's possible for it to be true both that it saves millions of lives and that it's dangerous to take unsupervised.

> A drug with a 10-50% success rate will still save a lot of lives.

There is zero evidence that it has anywhere near that level of effectiveness, even when combined with zinc and azithromycin for the most favorable population and conditions. It might have some effect, but touting it as a miracle cure when other treatments are already known with greater effect and lower risk is irresponsible.

Genius level here.... Drugs are dangerous.

www.henryford.com/news/2020/07/hydro-treatment-study

>The study that sparked the latest controversy was anything but randomized. Not only was it not randomized, outside experts noted, but patients who received hydroxychloroquine were also more likely to get steroids, which appear to help very sick patients with Covid-19. That is likely to have influenced the central finding of the Henry Ford study: that death rates were 50% lower among patients in hospitals treated with hydroxychloroquine.

>One study, the RECOVERY study conducted in the U.K., compared 1,542 patients on a particularly high dose of the drug to 3,132 control patients and found no difference in how long patients lived. A second, conducted by the National Institutes of Health, also found no benefit from hydroxychloroquine at higher doses.

It is dangerous, and the organization you linked to has been under heavy scrutiny for their so called "study".

https://www.deadlinedetroit.com/articles/25726/controversial...

Every drug is dangerous at improper dosage. It’s a fickle argument. It’s like trying to argue that people shouldn’t drink water, because if they had too much of it they’d drown or choke.

We prescribe drugs everyday with a proper dosage on the bottle, and people handle it just fine. This is no different.

Either way, HCQ is widely available and inexpensive, zinc is widely available and inexpensive, and I believe that is the crux of the real issue. Even if it worked for a small percentage of people, it’s still a significant tool in the fight.

The problem is, there is a coordinated push towards expensive patented drugs and vaccines on the population, we are watching marketing, propaganda, and censorship at this point.

Can’t have a $10 solution to a $10,000,000,000,000 problem.

I'm not sure why you're being downvoted. You're making a reasonable observation. Seems like when it comes to big drug manufacturers, suddenly big business and overgrown capitalists can do no wrong.

> I'm not sure why you're being downvoted.

Easy. It's a highly politicized thread, and in those sort of thread, driveby downvoting isnt uncommon, even on HN.

Dare I say: especially on HN? There's a lot of flagging for anything that may be construed as political. Some of it then gets restored by a mod overriding community moderation.

I have no idea about the amount that gets flagged, but I notice it quite a bit just by going to the front page and seeing something and if I happened to go back to it a minute later, poof, it's gone.

The opinion is a very stereotyped one, that has been very widely expressed all my life and probably far longer.

The conspiracy theory about the drug industry has been common forever, but it fits a more general pattern, like the Miracle Carburetor.

Obviously nobody can answer why something is downvoted, and discussing voting is discouraged, but personally, I'd like to see a controversial opinion that is original and interesting, not cliched.

Me, I wouldn't downvote something for only being wrong (IMO) or weird.

> I'm not sure why you're being downvoted

For calling HCQ a "$10 solution to a $10,000,000,000,000 problem". It's not.

You are spot in. There is just not enough money in it. Also it became a political issue after Trump mentiomed it, see: https://youtu.be/mnaYpmk8l1c?t=1047

> dangerous to take unsupervised

That's not what anyone is suggesting, and it seems disingenuous for you to suggest that it is. The drug is well-known, and it's reasonable to attempt its use when there's the potential for a large success rate. The people "hoarding" it are doctors who can get prescriptions for it - and who I imagine know more about the drug than you or I do.

Based on the Ford study [1], the 10-50% success rate might be a confusion with the hazard ratio reduction, which was 66%. The actual in-hospital mortality rates in that study were 20% with hydroxychloroquine + azithromycin vs. 26% with neither. I'd say a 6 percentage point difference in lives saved is enough to warrant further investigation.

[1] https://www.ijidonline.com/article/S1201-9712(20)30534-8/ful...

The Ford study is one of the weaker ones, it's a retrospective study and not a randomized controlled trial. There are better studies available, so it doesn't make sense to focus on this specific one that is inherently weaker and subject to more confounding factors than a randomized trial.

I'd love to hear about the better ones.

UK RECOVERY trial: https://www.bmj.com/content/369/bmj.m2263?ijkey=355d5085a0ae...

WHO SOLIDARITY trial (aborted due to lack of efficiency for hospital patients, still running for prophylaxis) https://www.who.int/emergencies/diseases/novel-coronavirus-2...

HCQ as prophylaxis trial: https://www.bmj.com/content/369/bmj.m2242?ijkey=2811796ab15e...

Here's another: https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa093...

> Evidence about use of hydroxychloroquine alone, or of hydroxychloroquine+azithromycin in inpatients, is irrelevant concerning efficacy of the pair in early high-risk outpatient disease. Five studies, including two controlled clinical trials, have demonstrated significant major outpatient treatment efficacy.

None of your sources deal with outpatients or the combination of hydroxychloroquine and azithromycin.

There is also a glaring conflict of interest regarding the author of that paper and some manufacturers of the drugs in question, https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa156...

I Spent a year trying to get a prescription for azithromycin before giving up.

I was explaining to a new doctor how my weird symptoms would go away on azithromycin or doxycycline for several weeks. He looked at me and said, oh you have an autoimmune disorder then. He even guessed the correct one. One I had never heard of.

He hadn’t read any studies on it. Was just something he noticed in decades of treating people.

It also looks like that study is still in the peer review process. It has the "Accepted Manuscript" flag (https://academic.oup.com/aje/pages/Instructions_To_Authors) and has at least one major error, https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa155...

> That's not what anyone is suggesting

...and yet that's what people are doing.

https://www.usatoday.com/story/news/nation/2020/07/07/teen-w...

> The drug is well-known

So are its risks.

> there's the potential for a large success rate

Every treatment has some potential. Funny how there's been a chorus of "eVerY drUg hAS rIsks" to make HCQ seem unexceptional in that regard (even though most drugs don't carry disk of heart problems and blindness) while clinging to the idea that its potential is exceptional. In the case of HCQ for COVID-19 we don't need to guess about potential, because there have been many studies by now and we have empirical evidence of weak effect. It shouldn't be ignored, but it should be far from the top of anyone's list either. It's only getting attention at all because of who keeps touting it.

You talk about being disingenuous, but I think the disingenuous behavior in this thread is the extreme cherry-picking of favorable results while ignoring less favorable results and risks.

> > That's not what anyone is suggesting

> ...and yet that's what people are doing.

> Her mother, a nurse, and a man identified in the report as her father, a physician assistant, gave the girl azithromycin...The report does not state if the girl had a prescription for either drug.

You need a better source. There was supervision in that case. Sadly, the girl was apparently part of the ~75-80% that don't survive COVID-19, even with azithromycin & hydroxychloroquine.

> So are its risks.

And that means its risks can be addressed and quantified.

> extreme cherry-picking

Two points. 1. A great example of cherry picking is the single instance of mortality associated with using azithromycin that you gave in your source. 2. The issue of degree of efficacy is secondary to the fact that it's potential for efficacy is being hidden and labeled disinformation, when the drug should be investigated for its potential to save lives.

> You need a better source. There was supervision in that case

You're being disingenuous again. Read the article. She was given the drugs by her parents, who were not authorized to prescribe them or supervise their use on their own. The outcome is not the point. The point is the lack of proper supervision. The outcome could have been different, and it would still be wrong for people to be using HCQ other than in a controlled trial ... but that's exactly what hype like yours leads to.

You're deriving way too much from an uninformative article. "Given the drugs by her parents" doesn't mean they were prescribed by her parents. Did the article say whether there was no doctor involved?

Also. The girl had an autoimmune disorder, for which the same drugs are commonly used. Did the article happen to say whether or not she was already on the drugs?

The article also says nothing about whether the drugs had anything to do with her demise. It sure does imply that, though.

This is a cherry picked article.

Love when people who get all their news from mainstream media news articles become experts at

It’s a prescription medication. Dosage is monitored. Side effects are monitored.

Personal experience 200mg and my rashes stop. My joint pain goes away. Lymph nodes stop swelling. My energy increases. Organ damage slows down.

400mg my hair gets really dry, and my blood pressure gets too high. Unless I skip caffeine.

Yearly eye tests are a thing. Some people go decades on it. Have to stop. And immediately all the old symptoms come back. “a flare”

This is a risk vs reward decision.

One issue is that its not a take a pill, cured tomorrow. It builds up in the system over time. It’s changing immune system behavior... slowly...

I was 30 days in before I noticed anything. 3 months until I was sure it was working. Doctor was shocked by my turn around after six months.

Lots of people say a year for full effectiveness.

The principle difference here is you are taking it for an autoimmune disease. Where the relative benefits outweigh the risks.

Equating that to using it “off label” for covid, either as a preventative (Like the president did)or treatment post infection, where there is little, if any, evidence of its effectiveness/benefits (but still with the same risks, and possibly more depending on the patient and their history) are two entirely different things.

They are in no way equal

Covid is an autoimmune disease. The Over active immune response is what is killing people.

The virus is a trigger. It also attacks exact same receptor that hydroxychloroquine targets. I think it’s complete nonsense that has no effect.

Maybe the effect is trivial. Maybe it’s too little too late. But it is way too early to shutdown talk on it down.

I desperately wanna see studies on Covid death rates for people that have been taking it long term.

> Covid is an autoimmune disease. The Over active immune response is what is killing people.

The virus triggers an acute immune response. This is not the same as an autoimmune disease, it may be the opposite. Also, people with certain blood types that have better clotting ability seem to be at a disadvantage.

Glad to hear everyone in this thread is a doctor, instead of investigators curious to look at potential solutions to covid besides a miracle vaccine (which no one is doubting the side effects of that by the way).

Including yourself, it seems, flippantly denouncing a potential vaccine.

While I would not trust someone posting here on HN about medical advice, I would trust doctors from around the world who have stated that, for example, hydroxychloroquine is not recommended for use against SARS-CoV-2, and I would absolutely trust them over any poster here and any politician.

More to your point: there may be potential solutions that are not a vaccine but I'll trust researchers and doctors to find those solutions, rather than doing the investigation myself, as they are much more highly trained than I ever will be on the subject.

No, that is just wrong.

SARS-COV-2 is a virus. It is not an autoimmune disease. Your immune system is not reacting to your own tissues. It is reacting to the virus, just like an immune system is supposed to. Immunology is very clear about this, though I admit that the details can be confusing at first. The lines get 'blurry' at the molecular level, Ship of Theseus, all that jazz.

Look, we all want hydroxychloroquine to work with covid-19. It would save a lot of lives, potentially. That's a great thing. If it works.

But we cannot administer it without good proof. Currently, the evidence seems to say that it does not work. It may change over time and with more research, but we can only go off of what we know today.

Actually, even in viral illnesses, the immune response can be a big cause of mortality and morbidity.

For example, in the 1918 flu pandemic, research has indicated the the immune response that it provoked was one of the reasons it was so deadly[0].

With SARS-COV-2 one of the treatments that has studies that show reduction in mortality is dexamethasone which is a steroid that reduces the inflammatory response (which is an immune response)[1].

So it is not unreasonable to think that an immune system modulating drug may help with SARS-COV-2. Whether or not hydroxychloroquinine specifically does is a different story, but it would not be surprising for something in this class to have a beneficial effect.

0. https://www.sciencedaily.com/releases/2006/09/060927201707.h...

1. https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

Isn’t that the entire point of vaccines though. To essentially give a small amount of exposure to your immune system so that it

A) knows how to deal with the pathogen specifically

B) doesn’t go wild and kill the host in its own right whilst trying to figure out how to properly deal with the pathogen

My understanding is that without exposure you body kinda throws a lot of different types of t-cells at the issue. Once it kinda knows how to handle it, it just throws the specific variant of t-cells needed.

T-cells work kinda like that, but as is typical in biology, the devil is in the details.

https://askabiologist.asu.edu/t-cell

I've taken it for malaria prevention when traveling as have millions of other people. You're acting like this is some super novel new compound that we have no experience with. It's not. You get a prescription for it and you talk to your doctor. Most medications have side effects, the medical system is designed to deal with that. Maybe it's not effective at treating COVID, but that's really irrelevant to the point the person was making.

Here's the full paragraph:

Cases and deaths averted. It is estimated that a cumulative 1.2 billion fewer malaria cases and 6.2 million fewer malaria deaths occurred globally between 2001 and 2015 than would have been the case had incidence and mortality rates remained unchanged since 2000. In sub-Saharan Africa, it is estimated that malaria control interventions accounted for 70% of the 943 million fewer malaria cases occurring between 2001 and 2015, averting 663 million malaria cases (range: 542–753 million). Of the 663 million cases averted due to malaria control interventions, it is estimated that 69% were averted due to use of insecticide-treated mosquito nets (ITNs) (UI: 63–73%), 21% due to artemisininbased combination therapy (ACT) (UI: 17–29%) and 10% due to indoor residual spraying (IRS) (UI: 6–14%).

My impression is that HCQ is not involved in any of the mentioned interventions, but is considered an alternative to ACT for some specific species.

But it is what's going on? I understand that it's helped in a lot of areas, but it seems like the general consensus is that corona is not one of those.

https://arstechnica.com/tech-policy/2020/07/donald-trump-jr-...

Medicine is not a popularity contest. There's good evidence that it is actually beneficial; insofar as popularity is important, note that Ars is only describing an official position, not a consensus.

Note also that most indications of its benefit are in conjunction with azithromycin and possibly zinc (that's not a no true scotsman, it's the consistent data), which the Ars source disregards.

"Real doctors". Are you talking about that breitbart propaganda piece? Even the camera shake was fake.

> That’s not what is going on. News broadcasters are denouncing it as dangerous,

It is dangerous, it has significant side effects. It is worth it for things where it has therapeutic utility, but clinical trials for it in COVID-19 keep coming back showing no benefit.

> A drug with a 10-50% success rate will still save a lot of lives.

It would. But one with no measurable benefit won't.

> This drug already saves millions of lives.

Perhaps; it is certainly useful for treating certain conditions that aren't COVID-19, and it should continue to go to people who need it for things it is effective in treating. No one is saying it's a bad drug, just that the evidence is that it's not a useful drug for treating COVID-19.

> no measurable benefit won't

Then I guess you're not talking about hydroxychloroquine, because there is evidence of a reduction in mortality rate.

https://www.ijidonline.com/article/S1201-9712(20)30534-8/ful...

That's not a clinical trial.

The actual clinical trials keep finding no benefit.

That's because the clinical trials aren't studying hydroxychloroquine in conjunction with azithromycin, which is where the effect is noticable. They have to actually study the thing that was indicated to work, if they're going to show it doesn't work.

This is one trial looking at both, and it didn't find any effect:

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014?query=fe...

I'm pretty sure there are more.

> That's because the clinical trials aren't studying hydroxychloroquine in conjunction with azithromycin, which is where the effect is noticable.

Wrong. See, e.g., https://medcitynews.com/2020/07/hydroxychloroquine-flunks-ph...

“Results of the randomized, controlled, open-label Phase III trial, which took place at more than two dozen sites in Brazil, were published in the New England Journal of Medicine on Thursday. The study randomized 667 patients to receive hydroxychloroquine or the drug plus the antibiotic azithromycin on top of standard of care or standard of care alone. When patients were measured on the seven-point ordinal scale of improvement in disease, those in the two hydroxychloroquine groups showed no improvement compared with patients who received standard of care alone. Moreover, those receiving hydroxychloroquine more frequently experienced Qt prolongation and elevation of liver enzymes.”

The specific circumstances where the drugs are effective aren't being met. I didn't look up the details before.

https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa093....

ICYMI lots of issues with that study, https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa155... https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa156...

I'm really sorry, I linked the wrong article. The quote in my comment is from the abstract of this [1] study. It's a meta-analysis by a professor of epidemiology at Yale. He also wrote an op-ed that ran in Newsweek. [2]

[1] https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa093...

[2] https://www.newsweek.com/key-defeating-covid-19-already-exis...

How is HCQ's effects on malaria even remotely relevant? Malaria is caused by a eukaryote parasite and SARS-CoV-2 is an RNA virus. They're radically different and unless you have some sources demonstrating some sort of biochemical pathway that is common to the two that HCQ affects, I don't see why you would even mention it.

I mean aspirin relives headaches, is part of the gold standard treatment for Kawasaki disease and prevents heart attacks and probably has fewer studies showing that it's not effective in the treatment of COVID-19, but that's no reason to speculate as to whether it'll prove to be another miracle cure.

> I don't see why you would even mention it

Because empirical results trump theory. I think you vastly overestimate how much we actually understand about the human body.

> That’s not what is going on. News broadcasters are denouncing it as dangerous, and we can’t talk about it. Social media is banning videos by actual doctors.

Certainly context is important here.

Taking regular antibiotics is also touted as dangerous and widely criticized because of the potential fallout effects of doing so, and yet I just finished a prescription of Moxifloxacin to resolve pneumonia and pleural effusion. It doesn't mean that the criticism is wrong.

And, forgive me if I'm mistaken, but isn't the video that was removed by a doctor who is known for citing some vaccines as coming from alien DNA and criticizing mask-wearing as a useless endeavour? If so, then I'm not terribly surprised. And regardless, I don't believe that falls under the definition of free speech anyhow—Twitter is a private company (this is the platform coming under fire for that, yeah?).

> As far as I understood, the distaste for the support of the drug in the context of Covid-19 was that it hasn’t been proven to be the “miracle cure” some people have touted it to be.

No, it's that in the various clinical trials, it keeps showing no improvement over existing treatments. It's not just not a miracle cure, the evidence is that it's not a useful treatment for COVID-19.

Thanks. I was trying to be as diplomatic as possible because I didn't have all of the information on hand to get into a medical debate. It's outside my lane.

Serious question: Who ever said it was a "miracle cure"?

Going by memory, the most notorious kind words on the subject of hydroxychloroquine were: "It may be a game-changer. Or, maybe not."

For some reason—I can't say what, exactly—that got spun by the media into something else entirely.

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