Again, you're lying, or not reading the reports, or both. Don't come here with such stupidity.
Rational CoViD-19 Discussion Thread: Science vs. Politics
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Again, you're lying, or not reading the reports, or both. Don't come here with such stupidity.
There's a point of high confidence coming out of the first two years of medical school (all didactic to that point) where you actually end up in the hospitals and clinics as a part of the treatment team. When you're actually thrust into the position of taking care of a patient, you suddenly realize that all that gazing at basic sciences didn't actually teach you clinical medicine. It's a humbling experience, and it helps reinforce the agnostic side of medical science. So while your statement states "benefit is 0," you have the added context of being able to say that that's not known yet by better contextualizing available evidence
tl;dr you may be standing at the apex of the Dunning-Kruger curve, and of course the perceived simpletons look small from that vantage point.
OK, folks, there is a lot of this OBtuseness going around. I just read a Politico piece, a NY Times article, and several others who are whoring after the DumpTrump audience. Here's my general response.
I don't think the FDA needs to do more than it has done, on the evidence and in the pressures of the moment, which is to allow the off-label use of HCQ in treatment of Covid. The side effects known for this drug, over hundreds of millions of prescriptive uses worldwide for malaria, and millions of uses for inflammatory arthritis and lupis and AIDS, need to be advertised or known to the patient, and reported if they occur..... but they are not sufficient reason not to try the HCQ if you have a Covid positive test result.
We will get a helluva lot of anecdoctal stuff as people make use of this without the circumstances and measures of a scientific test. The downside risk is factors of ten less than the upside probable results, which include slowing cytokine storm phenomena, secondary infections spreading to vital organs, stimulation of host immune responses, direct stimulation of oxygenation of the patient and direct killing of the virus through activation of oxidative enzymes.
Contrary to OB's lies above, the second Chinese study reported, for 31 treated patients, the reduction of the virus to nothing in most of the patients in six days.
The media that is goring the Pres for his "enthusiasm" here is defenseless in the light of these known facts.
(needs editing---see post below)
I don't think the FDA needs to do more than it has done, on the evidence and in the pressures of the moment, which is to allow the off-label use of HCQ in treatment of Covid. The side effects known for this drug, over hundreds of millions of prescriptive uses worldwide for malaria, and millions of uses for inflammatory arthritis and lupis and AIDS, need to be advertised or known to the patient, and reported if they occur..... but they are not sufficient reason not to try the HCQ if you have a Covid positive test result.
We will get a helluva lot of anecdoctal stuff as people make use of this without the circumstances and measures of a scientific test. The downside risk is factors of ten less than the upside probable results, which include slowing cytokine storm phenomena, secondary infections spreading to vital organs, stimulation of host immune responses, direct stimulation of oxygenation of the patient and direct killing of the virus through activation of oxidative enzymes.
Contrary to OB's lies above, the second Chinese study reported, for 31 treated patients, the reduction of the virus to nothing in most of the patients in six days.
The media that is goring the Pres for his "enthusiasm" here is defenseless in the light of these known facts.
(needs editing---see post below)
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OB's "Benefit Zero" stand requires him to dismiss all anecdotal claims to the contrary. Not many anecdotal claims out there for the zero benefit side.
OB's "Benefit Zero" stand requires him to dismiss quite a lot of scientific research papers that have been published in peer-reviewed journals as well, though none of them, of course, deal explicitly with this "novel virus".
OB's "Benefit Zero" stand requires him to ignore the link and discussion I posted above which concluded with a cautious positive opinion.....done by someone I'd judge to be both competent and mainstream in his professional expertise.
"So you can see that these two came out rather differently, with the Zhejiang study showing no detectable difference on treatment and the Wuhan one showing what looks like a real effect, especially on radiological progression of pneumonia (which I have to say is a very strong endpoint to measure). Here, then, is a good exercise in interpreting clinical trial statistics: we are now one-and-one after two small hydroxychloroquine trials: which one (if either) reflects the real-world situation?"
https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-trials
Anecdotal evidence is not "no evidence". In a contest where there is nothing we can say one way or another, we should expect approximately equal numbers of folks saying this, as that. Where you have few, if any, anecdotal claims on the negative propostion, the positive deserves some credence.
Then there is the whole idea of experience, where you have experienced observers whose observations on the subject deserve respect, and such observations should be taken for having meaning.
The science will come along, in time..... but we have a decision to make today.
I agree with Trump that this shows some hope, some promise, and that we should do what we can to prove it out.... make the drug available to those who want it, to those doctors who want to try it, ASAP.
OB's "Benefit Zero" stand requires him to dismiss quite a lot of scientific research papers that have been published in peer-reviewed journals as well, though none of them, of course, deal explicitly with this "novel virus".
OB's "Benefit Zero" stand requires him to ignore the link and discussion I posted above which concluded with a cautious positive opinion.....done by someone I'd judge to be both competent and mainstream in his professional expertise.
"So you can see that these two came out rather differently, with the Zhejiang study showing no detectable difference on treatment and the Wuhan one showing what looks like a real effect, especially on radiological progression of pneumonia (which I have to say is a very strong endpoint to measure). Here, then, is a good exercise in interpreting clinical trial statistics: we are now one-and-one after two small hydroxychloroquine trials: which one (if either) reflects the real-world situation?"
https://blogs.sciencemag.org/pipeline/archives/2020/03/31/comparing-chloroquine-trials
Anecdotal evidence is not "no evidence". In a contest where there is nothing we can say one way or another, we should expect approximately equal numbers of folks saying this, as that. Where you have few, if any, anecdotal claims on the negative propostion, the positive deserves some credence.
Then there is the whole idea of experience, where you have experienced observers whose observations on the subject deserve respect, and such observations should be taken for having meaning.
The science will come along, in time..... but we have a decision to make today.
I agree with Trump that this shows some hope, some promise, and that we should do what we can to prove it out.... make the drug available to those who want it, to those doctors who want to try it, ASAP.
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Those are the side effects associated with this specific drug.
I agree neither study was of high quality. Nevertheless, the Wuhan study was worse.
Again, I'm telling the truth, not confusing reporting anecdotes with data (both). I'll come here with reality as often as I think it called for.
How about we put it this way: there is as much reliable evidence for the use of HQC in treatment of COVID19 as there is for allowing spiders to run around your face as a treatment for COVID19. Would you support spider therapy being used? Do we evidence spider therapy won't work?
I'm well aware there's all kinds of stuff we don't know, and of my ignorance.
Let's try a different thought: how would you feel about a doctor using a chemotherapy regimen to treat COVID19?
The problem being that there is no good reason to try HCQ.
This is from the article you quoted:
So you can see that these two came out rather differently, with the Zhejiang study showing no detectable difference on treatment and the Wuhan one showing what looks like a real effect, especially on radiological progression of pneumonia (which I have to say is a very strong endpoint to measure).
If you look at the data shown from the Zhejiang study, both groups showed a reduction in the virus to next to nothing in six days.
none of them are common occurrences. Some are associated with other conditions, mostly not very common. A doctor can sort out these risks. Not a reason to just not consider using it at all.
Let's put it this way: A train is coming down the track at 90mph, and you are stuck on the crossing. You are arguing that we are all safer staying in our car rather than undoing our seat belt and trying to get away. So many people get strangled in those seat belts when they try to release them and get out quickly. I know. It's tragic when that happens, and we sue the seat belt company.
I misread the table the first time I looked at it, and then I just had to wonder about the study selection criteria and monitoring/accuracy of results. 62 patients selected when the plan was for 100 in each, and you really just have to worry about compliance with the study if the patients know they might be getting placebo. Both groups, I presume, were getting some standard treatment other than the HCQ.
The anecdotal stories massively report elimination of the virus in about six days, supported by many experienced doctors doing their business of trying to save patients somehow.
Not enough science to back your stand, bro.
widespread experience with HCQ reports general antiviral side effects in cases of malaria, lupus, arthritis, other autoimmune disease and inflammatory conditions. And it has been seen invitro to just flat stop certain viruses. multiple modes of antiviral action at work.
quinine, the natural product which our pharma industry once rendered patentable by some modification, is similar in many effects, if not so effective. Chemically, the molecule would be classed as an oxidizing agent toxic to corona viruses in general.
The one valid objection to arguing about HCQ or relying on it as a cure, is the fact that there are other good choices or selections we could be looking at as well.
And rather than quarrel here with you any more, I'm going to look at some of those.
Y
we know quite a bit about our chemotherapy regimens as well. Some have use as antiviral agents as well as anticancer, considering a common enzyme necessary for DNA replication is sometimes involved in both. Corona viruses are RNA viruses, not DNA virus. Not many, if any, anticancer drugs act on RNA replication. Some antiviral agents act on DNA replication, and could be useful in the case of a DNA virus.
We know a lot about spider venom, as well. And snake venom. Some folks think these venoms have materials that could be useful in some human treatments.
But really, your objections here are inane because we have quite a lot of experience with HCQ and some close relatives, on millions of human applications. We know the side effects are not important, relatively, to almost anything else we could possibly try. And we have plenty of good reason to believe HCQ has good clinical effect favorable to Covid patients.
Maybe you won't believe it until the ten year, double double blind study is completed. Good luck looking for the willing placebo and ten comparative treatment cohorts for your study. ten thousand randomly selected patients in each cohort. My Gawd. Meanwhile, just claiming there is no good reason to think it helps is lying straightfaced to people who can be helped, when you know what I say here is the truth.
so anyway, back to the science...… pretty damn certain the dumptrump and socialist solution pushers won't let this crisis go for a decade.
When you give a drug to millions of people, rare occurrences happen, particularly to people who don't know they have certain conditions or don't share that information.
In this metaphor, we also happen to be in a tunnel with no room on the sides to avoid the train, so getting out adds nothing to our changes of survival.
Apparently, its also about 6 days without HCQ. I agree we don't have a quality study yet.
Exactly. That's my point. You don't give drugs to randomly.
Anecdotally, but never in formal studies.
It would be if it actually did something.
Trump won't be President for the next decade, will he?
(needs editing---referring to post above comparing two early Chinese studies available now)
I think I got confused on the evaluation given for these studies. Too clarify, here is the comparison data presented, and the author's remarks following:
Here’s a comparison between the two:
So you can see that these two came out rather differently, with the Zhejiang study showing no detectable difference on treatment and the Wuhan one showing what looks like a real effect, especially on radiological progression of pneumonia (which I have to say is a very strong endpoint to measure). Here, then, is a good exercise in interpreting clinical trial statistics: we are now one-and-one after two small hydroxychloroquine trials: which one (if either) reflects the real-world situation?
I think I said the studies showed 90% clearance of the virus after six days. No. That is anecdotal stuff from other sources.
The author here gave the HCQ a cautious positive or hopeful signal in the end, but noted several deficiencies and missing data in the report. And noted that it is disturbing that a study envisioning two 100 patient cohorts only came up with 31. Pretty hard to convince people to take a placebo (in any theoretical scenario) when on death's door. I suspect both studies were using less serious patients. Another problem is the reliability of even PCR tests when false positives coming from other corona types are being wailed about, at least in the labs if not by management. again, a rapidly mutating virus.....
I think I got confused on the evaluation given for these studies. Too clarify, here is the comparison data presented, and the author's remarks following:
Here’s a comparison between the two:
So you can see that these two came out rather differently, with the Zhejiang study showing no detectable difference on treatment and the Wuhan one showing what looks like a real effect, especially on radiological progression of pneumonia (which I have to say is a very strong endpoint to measure). Here, then, is a good exercise in interpreting clinical trial statistics: we are now one-and-one after two small hydroxychloroquine trials: which one (if either) reflects the real-world situation?
I think I said the studies showed 90% clearance of the virus after six days. No. That is anecdotal stuff from other sources.
The author here gave the HCQ a cautious positive or hopeful signal in the end, but noted several deficiencies and missing data in the report. And noted that it is disturbing that a study envisioning two 100 patient cohorts only came up with 31. Pretty hard to convince people to take a placebo (in any theoretical scenario) when on death's door. I suspect both studies were using less serious patients. Another problem is the reliability of even PCR tests when false positives coming from other corona types are being wailed about, at least in the labs if not by management. again, a rapidly mutating virus.....
I think what I said was that socialists are not going to go away for at least ten years, whoever the hell is Pres. And they won't quit working the ropes of any crisis that can win a vote.
Saying this is consistent with your despair that we have anything on our medical regimen repertoire that can make a difference. But that's the difference between you and me.
Looking around..... and in fact going around.... the Utah/Nevada/California loop, I can say people are doing a fair job social distancing, and that we are seeing fair results just from that. Public health measures are being practiced quite well, even in the stores that are open. Lots of places have shields in place separating customers from clerks or employees, almost every place is using masks, most stores have sanitizing wipes at the entrance/exit. We have good temp sensors too, in conspicuous use.... you have to have your temp taken to cross the blue line..... stuff like that everywhere.
The antibiotics, useful to fight the secondary infection/cytokine storm of serious cases, are being evaluated for their usefulness here in practical comparative experience, if not in scientific studies. And a number of antivirals are being tried as well. Our doctors are learning daily from their experience, and their success stats will be showing it. Hard to see what HCQ is doing with so many variables going on.,maybe….. but still..... doctors can see what there is to see day by day.
So here is a report from Wuhan..... reflecting my own viewpoint very well..... about all the things that have been done, and new studies that have been launched.
https://www.wired.com/story/china-launches-a-crush-of-clinical-trials-aimed-at-covid-19/
https://www.wired.com/story/china-launches-a-crush-of-clinical-trials-aimed-at-covid-19/
