Efficacy of hydroxychloroquine in patients with Covid-19: a randomized trial(medrxiv.org)
medrxiv.org
Efficacy of hydroxychloroquine in patients with Covid-19: a randomized trial
https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2
122 comments
You live on Reunion? What is that like?
Yep I live on Reunion. I might be biased, as I was born there, but if you have a job, a decent house, and loves nature living here is quite pleasant. It's like France with less grumpy people, tropical weather but with some third-world issues. Problem is jobs are scarce and aren't well paid (unless you're a french expat) and rents are astronomical.
> It's sad to see scientific method destroyed by politics and social networks.
If there were such a thing as phase 5 trials with at least a million participants, it would be completely insane to use anything that had only undergone phase 3 clinical trials. People should make rational decisions based on the best evidence that's available at the time. Whether or not it's rational to take HCQ, there's nothing magical about phase 3 studies.
Antiviral drugs only really work in the first couple days of the illness, and with this disease you usually don't get symptoms until at least day 5. And in the current environment, no one is getting put on prescription antivirals until at least day 10, and usually even later. To me this raises the question of whether clinical trials are really even possible right now in the first place, or whether making decisions based off in vitro data is the best we can do for right now.
If there were such a thing as phase 5 trials with at least a million participants, it would be completely insane to use anything that had only undergone phase 3 clinical trials. People should make rational decisions based on the best evidence that's available at the time. Whether or not it's rational to take HCQ, there's nothing magical about phase 3 studies.
Antiviral drugs only really work in the first couple days of the illness, and with this disease you usually don't get symptoms until at least day 5. And in the current environment, no one is getting put on prescription antivirals until at least day 10, and usually even later. To me this raises the question of whether clinical trials are really even possible right now in the first place, or whether making decisions based off in vitro data is the best we can do for right now.
>To me this raises the question of whether clinical trials are really even possible right now in the first place, or whether making decisions based off in vitro data is the best we can do for right now.
I don't think I understand this. We have a clinical trial with in vivo data right here though, right?
I don't think I understand this. We have a clinical trial with in vivo data right here though, right?
> We have a clinical trial with in vivo data right here though, right?
AFAIK there's no clinical trial data, but there is in vivo data. My point though is that these are drugs that block viral replication, and we're mostly only administering them after the virus has already finished replicating. So in that scenario of course it's going to look ineffective regardless of whether it actually works or not. I don't believe the data showing it works, but I also don't believe the data showing it doesn't work.
AFAIK there's no clinical trial data, but there is in vivo data. My point though is that these are drugs that block viral replication, and we're mostly only administering them after the virus has already finished replicating. So in that scenario of course it's going to look ineffective regardless of whether it actually works or not. I don't believe the data showing it works, but I also don't believe the data showing it doesn't work.
When you say clinical trial, what are you meaning? I think the usual definition would include this paper as a clinical trial. Do you mean the FDA hasn't overseen any clinical trials?
Also, why don't you believe the data? or is it the conclusions that the researchers draw from the data that you don't believe? The statistics and trial design in this paper seem to be sound.
Also, why don't you believe the data? or is it the conclusions that the researchers draw from the data that you don't believe? The statistics and trial design in this paper seem to be sound.
The sample size is 62 and the mortality rates are between 0% and 7% depending primarily on age and co-morbidities. I don't think we can draw any meaningful conclusions from this other than what we already know: seems worth looking into HCQ more.
They weren't looking at the effects on mortality. They looked at TTCR ("the return of body temperature and cough relief, maintained for more than 72 h") and radiological changes. They found a decently large effect in both of these.
The meaningful conclusion is "Considering that there is no better option at present, it is a promising practice to apply HCQ to COVID-19 under reasonable management."
The meaningful conclusion is "Considering that there is no better option at present, it is a promising practice to apply HCQ to COVID-19 under reasonable management."
Also, you don't need to decrease mortality to have a huge benefit from a treatment. If you just get people recovering faster, you've probably indirectly saved many lives!
How does the 2 cases of collateral effects compare to the normal consequences of the drug? It is very likely that we can draw conclusions about those.
The side effects were a headache and a rash, neither one serious. The worrisome side effects of HCQ are also given in the paper: "Retinopathy is one of the major adverse reactions of long-term therapy with HCQ. Besides, patients with rheumatoid diseases treated with HCQ occasionally experience arrhythmias."
Luckily, long-term use of the drug isn't necessary here because the immune system successfully responds with antibodies to fight of the virus, so retinopathy isn't an issue. Also, as the paper states, "Fortunately, deciding on individual treatment plans scientifically, monitoring adverse reactions timely, to avoid overdose, short-term application of HCQ is relatively safe."
Luckily, long-term use of the drug isn't necessary here because the immune system successfully responds with antibodies to fight of the virus, so retinopathy isn't an issue. Also, as the paper states, "Fortunately, deciding on individual treatment plans scientifically, monitoring adverse reactions timely, to avoid overdose, short-term application of HCQ is relatively safe."
So, evidence is pointing that we have a drug that drastically reduces hospitalization time for the milder cases, can save some 5-10% of the grave cases and is perfectly safe as long as there is a doctor looking at the patients. That is really looking like a large win.
This is one of the drugs on the large study WHO is running worldwide, and is getting a lot of attention. I'm sure we'll have strong evidence either way soon.
This is one of the drugs on the large study WHO is running worldwide, and is getting a lot of attention. I'm sure we'll have strong evidence either way soon.
I don't know that this study is talking about reduced hospitalization times. In fact, mild cases don't end up in the hospital. However, it could be that mild cases end up turning into severe cases that need hospitalization less frequently if this treatment is used. Since hospitalization is only needed in some 20% of cases, it would probably take a larger study to meaningfully determine those effects.
Of course, (and even though this probably isn't the case) if all this treatment does is make the mild and moderate cases (those without and with pneumonia and not needing supplemental oxygen) end faster, we can get to herd immunity that much quicker.
And yes, people are using this drug and are going to be using this drug at an increasing rate, so we'll have plenty of evidence soon.
Of course, (and even though this probably isn't the case) if all this treatment does is make the mild and moderate cases (those without and with pneumonia and not needing supplemental oxygen) end faster, we can get to herd immunity that much quicker.
And yes, people are using this drug and are going to be using this drug at an increasing rate, so we'll have plenty of evidence soon.
I know someone with Lupus, as I'm sure many people do. This is really good news for most everyone right now. But for people who need these types of drugs to fight Lupus (and I'd assume many other diseases) this is really bittersweet because they can either not get it at all now, or only get a very small amount. It's good to see this is going to help people with Covid-19, I really hope the drug makers can get this production ramped up fast so others that need these drugs can get what they need again.
"Key findings: For the 62 COVID-19 patients, 46.8% (29 of 62) were male and 53.2% (33 of 62) were female, the mean age was 44.7 (15.3) years. No difference in the age and sex distribution between the control group and the HCQ group. But for TTCR, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia."
“ Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia.”
So hate to ask this, can you explain this for non-medical spectators? Specifically what TTCR and is "absorption of pneumonia" a good thing (e.g. the body has absorbed the pneumonia and therefore it has gone away) or a bad thing (e.g. the body has absorbed the pneumonia and therefore has "collected" more)?
From Paper:
TTCR: Time to clinical recovery
From Paper:
TTCR: Time to clinical recovery
I have a feeling that this is a mistranslation, not jargon. Other similar usage of "absorption" that I can find was also written by Chinese researchers.
edit: got downvoted, so adding link to only other "absorption of pneumonia" use that I could find: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344839/
edit2: I could also find some usage of "absorption of inflammation", again also all Chinese researchers.
edit: got downvoted, so adding link to only other "absorption of pneumonia" use that I could find: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344839/
edit2: I could also find some usage of "absorption of inflammation", again also all Chinese researchers.
In pneumonia, areas of the lungs fill with fluid. This prevents the area from filling with air, which therefore prevents the exchange of CO2 and O2 between the blood and air.
I will assume that 'absorption' in this sense refers to the fluid. It's a good thing when this happens, because that that area of the lung can be accessed by air again.
I will assume that 'absorption' in this sense refers to the fluid. It's a good thing when this happens, because that that area of the lung can be accessed by air again.
It's worth noting that this study does not include azithromycin in the treatment regime, as was the case in the Raoult/French study.
The French study, problematic in the extreme but still promising, claims a large synergistic effect of using both drugs in combination.
Also, unlike the French study, this one appears to be at least controlled, but possibly not blinded.
The French study, problematic in the extreme but still promising, claims a large synergistic effect of using both drugs in combination.
Also, unlike the French study, this one appears to be at least controlled, but possibly not blinded.
I think this counts a double blind trial. From the top of page 4 in the article:
"Randomization was performed through a computer-generated list stratified by site. Treatments were assigned after confirming the correctness of the admission criteria. Neither the research performers nor the patients were aware of the treatment assignments."
Seems relevant: https://twitter.com/SquawkCNBC/status/1245669685267439616
Not sure they've been doing proper studies and such because they're so slammed, but it seems they've been trying it in Italy and... maybe it helps some, but doesn't seem like it works miracles.
Not sure they've been doing proper studies and such because they're so slammed, but it seems they've been trying it in Italy and... maybe it helps some, but doesn't seem like it works miracles.
In combination with antibiotics and (it seems) zinc it looks quite effective.
A doctor in NY has treated with that combination and is up to almost 700 COVID-19 patients without one dying _or needing a ventilator_.
Some relevant quotes:
>Dr. Zelenko said the whole treatment costs only $20 over a period of 5 days with 100% success. He defines success as “Not to die.” Dr. Zelenko first posted his Facebook video message last week calling on President Trump to “advise the country that they should be taking this medication.”
>There are many other success stories about hydroxychloroquine across the country. Last week, Dr. William Grace, an oncologist at Lenox Hill Hospital in New York City, said they’ve not had a single death in their hospital because of hydroxychloroquine. “Thanks to hydroxychloroquine, we have not had a death in our hospital,’ Dr. Grace said.
From:
https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-...
When people are dying in large numbers, sometimes "anecdotal evidence" (especially with large samples) is plenty.
A doctor in NY has treated with that combination and is up to almost 700 COVID-19 patients without one dying _or needing a ventilator_.
Some relevant quotes:
>Dr. Zelenko said the whole treatment costs only $20 over a period of 5 days with 100% success. He defines success as “Not to die.” Dr. Zelenko first posted his Facebook video message last week calling on President Trump to “advise the country that they should be taking this medication.”
>There are many other success stories about hydroxychloroquine across the country. Last week, Dr. William Grace, an oncologist at Lenox Hill Hospital in New York City, said they’ve not had a single death in their hospital because of hydroxychloroquine. “Thanks to hydroxychloroquine, we have not had a death in our hospital,’ Dr. Grace said.
From:
https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-...
When people are dying in large numbers, sometimes "anecdotal evidence" (especially with large samples) is plenty.
This news story raises several big red flags.
This story was reported by Laura Ingraham on Fox News. Her tweet promoting this as a "cure" was immediately withdrawn by Twitter as "misleading". The 40 minute video interview with Zelenko, again on Fox News, was conducted not by a medical reporter, but by Rudy Giuliani. Zelenko goes on to make numerous huge dire public health predictions -- none of which a family practitioner has any business suggesting, especially in public on a national news outlet.
As always, consider the source of the information.
It's also very important to note that Zelenko was treating 700 unhospitalized patients; these were not cases severe enough to admit to a hospital. He treated them from his home (since he lost a lung to cancer years ago). So he never actually physically met with any of those 700 patients to monitor their progress.
In fact it's likely that many of these patients never tested positive, but simply self-reported as positive, further diluting the 'trial'.
And because 80% of positive COVID-19 cases are minor or even asymptomatic, the number of his patients that really _needed_ treatment falls from 700 down to, at most, 140 (20% of 700). That's a much smaller treatment effect that a large number like 700 would suggest.
It's also important to note that, apparently, Dr Zelenko treated sick people with medications that were NOT approved for the target disease. And he did so apparently without approval from any higher public health authority. In short, it appears that he experimented on his patients without authorization to do so from a public health or research authority.
Zelenko is a family medicine doctor, not a specialist in infectious disease or research. Thus it's very unlikely he wrote up an experimental design with proper safeguards, much less got it approved. With such poor experimental controls, it's impossible to interpret his results. What's more, if any of his patients later incur harm (like heart attacks from the chloroquine), such a laissez-faire approach to medicine will invite lawsuits galore.
No. Anecdotal evidence alone is NEVER enough.
This story was reported by Laura Ingraham on Fox News. Her tweet promoting this as a "cure" was immediately withdrawn by Twitter as "misleading". The 40 minute video interview with Zelenko, again on Fox News, was conducted not by a medical reporter, but by Rudy Giuliani. Zelenko goes on to make numerous huge dire public health predictions -- none of which a family practitioner has any business suggesting, especially in public on a national news outlet.
As always, consider the source of the information.
It's also very important to note that Zelenko was treating 700 unhospitalized patients; these were not cases severe enough to admit to a hospital. He treated them from his home (since he lost a lung to cancer years ago). So he never actually physically met with any of those 700 patients to monitor their progress.
In fact it's likely that many of these patients never tested positive, but simply self-reported as positive, further diluting the 'trial'.
And because 80% of positive COVID-19 cases are minor or even asymptomatic, the number of his patients that really _needed_ treatment falls from 700 down to, at most, 140 (20% of 700). That's a much smaller treatment effect that a large number like 700 would suggest.
It's also important to note that, apparently, Dr Zelenko treated sick people with medications that were NOT approved for the target disease. And he did so apparently without approval from any higher public health authority. In short, it appears that he experimented on his patients without authorization to do so from a public health or research authority.
Zelenko is a family medicine doctor, not a specialist in infectious disease or research. Thus it's very unlikely he wrote up an experimental design with proper safeguards, much less got it approved. With such poor experimental controls, it's impossible to interpret his results. What's more, if any of his patients later incur harm (like heart attacks from the chloroquine), such a laissez-faire approach to medicine will invite lawsuits galore.
No. Anecdotal evidence alone is NEVER enough.
Edit: Thanks for linking to the source
Snopes has more details of side-effects etc: https://www.snopes.com/fact-check/zelenko-669-coronavirus-pa...
Snopes has more details of side-effects etc: https://www.snopes.com/fact-check/zelenko-669-coronavirus-pa...
Snopes has it marked as unproven, so it just means that they're waiting for more results to come in.
For anybody who's interested, here's an interview with the doctor himself: https://forward.com/news/national/442285/coronavirus-hydroxy...
For anybody who's interested, here's an interview with the doctor himself: https://forward.com/news/national/442285/coronavirus-hydroxy...
Some of the papers being shared on r/COVID19 seem to be indicating that perhaps it has little effect once the disease has gotten severe, but if taken early, may reduce potential severity and time to recovery. Still early, but it seems like, if the results end up being true, it could be helpful in stemming the tide of the disease.
I've heard this too. Here's an explanation that sounds plausible:
https://twitter.com/yishan/status/1244717172871409666
https://twitter.com/yishan/status/1245066858597761024
If true, this argues for giving HCQ immediately upon admission.
https://twitter.com/yishan/status/1244717172871409666
https://twitter.com/yishan/status/1245066858597761024
If true, this argues for giving HCQ immediately upon admission.
View from a pharma-focused organic chemist:
https://blogs.sciencemag.org/pipeline/archives/2020/03/31/co...
TL;DR: better than the French paper but that's a low, low bar
https://blogs.sciencemag.org/pipeline/archives/2020/03/31/co...
TL;DR: better than the French paper but that's a low, low bar
Sample size seems small. Is this adequately powered given the effect size?
Power wouldn't be a concern here. Power is simply the probability that, if a statistically significant difference exists, the study correctly conclude there is a difference. Essentially, if a study comes back failing to reject the null hypothesis ("there is no benefit to hydroxychloroquine"), then you might be concerned about power ("perhaps there is a benefit and our sample size was too small to detect it"). There may be other statistical points to be raised about the results of this study, but given that the null was rejected ("there was evidence of an effect of HCQ"), power wouldn't be among them.
Here the null hypothesis is that hydroxychloroquine isn't any better than not receiving anything. If the study
Here the null hypothesis is that hydroxychloroquine isn't any better than not receiving anything. If the study
So it works?
It looks as if this was better executed than the earlier, criticized study, but with just 2x32 patients, we'll probably have to wait for replication.
One thing that certainly should be cleared up is the age effect: they report "No difference in the age ... distribution ", but that's not enough.
One thing that certainly should be cleared up is the age effect: they report "No difference in the age ... distribution ", but that's not enough.
Too small a sample size to say.
Could you show me the statistics/theory that show that this is too small a sample size to make meaningful decisions from?
Statistical significance: https://en.wikipedia.org/wiki/Statistical_significance
So, are you trying to say that the results that the researchers say are statistically significant aren't actually statistically significant? They give their numbers in the paper and the p-values are less than everyone's favorite threshold (.05).
If you are trying to say that their sample size was too small to find an effect using null hypothesis testing, then that makes no sense.
If you are trying to say that their sample size was too small to find an effect using null hypothesis testing, then that makes no sense.
It sorta works. Its not a cure, but it seems to help.
I wish the current U.S. administration hadn't tried to turn this into a partisan issue.
How did they turn it into a partisan issue? Trump announced in a press conference that hydroxychoroquine held promise as a potential therapy based on anecdotal evidence being shared by physicians in Asia and Europe. Everyone, Democrats, the media, and individuals jumped on him as promoting snake oil and having no basis for his claims. It was barely news when he announced it. Some of the same evidence he was referencing in his claims had been circulating in preprints and on subs like r/COVID19 for weeks at that point.
I strongly dislike the administration generally, but I've been perplexed as to how eager everyone has been to attack him over this particular incident. And if it was made partisan, it seems like it was done so by others, and not the administration itself.
I strongly dislike the administration generally, but I've been perplexed as to how eager everyone has been to attack him over this particular incident. And if it was made partisan, it seems like it was done so by others, and not the administration itself.
He heard something about these two drugs, and without any scientific evidence he announced it, causing a panic-grab for the drugs. Unfortunately even the CDC was saying we don't have evidence supporting it.
> He heard something about these two drugs, and without any scientific evidence he announced it, causing a panic-grab for the drugs.
And? As I said, there has been some anecdotal evidence coming from countries like China, SK, and France indicating it could help. It shouldn't be a strike against a government official for sharing potentially important information. At a certain point we need to stop blaming people in positions of authority for the stupidity that exists among individuals in society. I'd rather my government be open and transparent than hide information from me because the more idiotic portions of the population may react poorly.
Its also worth noting that Hydroxychloroquine is unavailable in the US without a prescription. The "panic-grab" you are seeing is entirely due to physicians buying for themselves and their family/friends. Definitely sleazy, but they are hardly uninformed.
> Unfortunately even the CDC was saying we don't have evidence supporting it.
The CDC has proven itself to be conservative and slow to the point of harmful ineptitude. A huge part of the reason the situation in the US has diverged so much from countries that have managed to successfully clamp down on the disease (like SK) is because they insisted that testing rely on their own, overengineered procedures, and because they've insisted (for at least a decade now) that masks are only beneficial for HCPs, despite numerous studies to the contrary and the advice of nations like those in East Asia. Now, after the cat is well out of the bag, they've opened up testing to private companies and other testing procedures, and are now beginning to say that regular people should in fact be using masks to prevent the spread of the disease.
An appeal to authority is a fallacy on the best of days. Its even worse when said authority is in the midst of the most incompetent moment in its history.
And? As I said, there has been some anecdotal evidence coming from countries like China, SK, and France indicating it could help. It shouldn't be a strike against a government official for sharing potentially important information. At a certain point we need to stop blaming people in positions of authority for the stupidity that exists among individuals in society. I'd rather my government be open and transparent than hide information from me because the more idiotic portions of the population may react poorly.
Its also worth noting that Hydroxychloroquine is unavailable in the US without a prescription. The "panic-grab" you are seeing is entirely due to physicians buying for themselves and their family/friends. Definitely sleazy, but they are hardly uninformed.
> Unfortunately even the CDC was saying we don't have evidence supporting it.
The CDC has proven itself to be conservative and slow to the point of harmful ineptitude. A huge part of the reason the situation in the US has diverged so much from countries that have managed to successfully clamp down on the disease (like SK) is because they insisted that testing rely on their own, overengineered procedures, and because they've insisted (for at least a decade now) that masks are only beneficial for HCPs, despite numerous studies to the contrary and the advice of nations like those in East Asia. Now, after the cat is well out of the bag, they've opened up testing to private companies and other testing procedures, and are now beginning to say that regular people should in fact be using masks to prevent the spread of the disease.
An appeal to authority is a fallacy on the best of days. Its even worse when said authority is in the midst of the most incompetent moment in its history.
"And?..." Seriously? If there's panic buying (or prescribing, as did occur) then supplies are diminished if not depleted. WHAT GOOD IS THAT?
As I said, the only people prescribing this stuff are actual physicians. You are assuming that a trained MD is going to start prescribing this stuff willy-nilly based on two sentences by the president? If that actually occurs, it's because they agree with him and are prescribing them as they see fit. There isn't "panic" in the equation. Its physicians trying to help their patients.
No but doctors do respond to pressure from patients who will respond to two sentences from the president.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151257/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151257/
So to be clear, you believe there is a massive run on hydroxychloroquine because Trump mentioned it in a sentence or two as having promise in a press conference, and now thousands and thousands of patients are strong-arming their physicians into giving them prescriptions for it?
Even if that wasn't a ridiculous stretch and was actually happening, that's on the shitty doctors, not the president.
Even if that wasn't a ridiculous stretch and was actually happening, that's on the shitty doctors, not the president.
It is not a ridiculous stretch. Drug companies advertise directly to individuals on popular TV for exactly this reason.
>> He heard something about these two drugs, and without any scientific evidence he announced it, causing a panic-grab for the drugs. Unfortunately even the CDC was saying we don't have evidence supporting it.
He simply reported that it looked promising in early studies, like we had already seen reported here on HN. His other action was apparently to lean the FDA to find out ASAP rather than heming and hawing for years following standard beaurocratic protocols. I think it was fine to do both those things. Responsible even.
He simply reported that it looked promising in early studies, like we had already seen reported here on HN. His other action was apparently to lean the FDA to find out ASAP rather than heming and hawing for years following standard beaurocratic protocols. I think it was fine to do both those things. Responsible even.
You are talking about the president as if he is just some guy BSing at a BBQ. By discussing an unproven treatment he knowingly or not put his thumb on the scale of science, which is generally something we do not want.
We don't want scientific investments made because the president seems into them. We want those choices made by experts who are hopefully disinterested as possible. We want them considering the most likely successful treatments from their expert point of view.
You essentially can't have that now. And this goes beyond influence. The administration has been leaning on the FDA to give this ememgency approval.
This appears safe from the very preliminary studies we have but problems can develop at scale. These drugs are known to cause heart rhythm issues. It's conceivable that deploying then at scale in an emergency could lead to increase in fatal cardiac episodes. Were this drug not to actually work, large scale deployment would almost certainly do more harm than good.
The presidential podium confers added weight to everything a person says for good or ill and therefore should be used cautiously.
We don't want scientific investments made because the president seems into them. We want those choices made by experts who are hopefully disinterested as possible. We want them considering the most likely successful treatments from their expert point of view.
You essentially can't have that now. And this goes beyond influence. The administration has been leaning on the FDA to give this ememgency approval.
This appears safe from the very preliminary studies we have but problems can develop at scale. These drugs are known to cause heart rhythm issues. It's conceivable that deploying then at scale in an emergency could lead to increase in fatal cardiac episodes. Were this drug not to actually work, large scale deployment would almost certainly do more harm than good.
The presidential podium confers added weight to everything a person says for good or ill and therefore should be used cautiously.
I can't believe I have to say this, but the POTUS is not some hacker news comment. What they say has large and far reaching consequences and they shouldn't be spouting off about anecdotal evidence. Their comments had already caused a shortage of HCQ, and led to at least one death.
>If the doctor now publicly claiming 699 treatments with 0 deaths using HCQ turns out to be a blatant fraud I think he may well lose his license given the situation.
I don't think the boards of medical quality assurance of the 50 states care enough about public statements to yank the license of (or even to discipline) a doctor for making a public statement the doctor knew to be false. In general the US medical profession doesn't have the commit to truth that, e.g., physicists do.
I don't think the boards of medical quality assurance of the 50 states care enough about public statements to yank the license of (or even to discipline) a doctor for making a public statement the doctor knew to be false. In general the US medical profession doesn't have the commit to truth that, e.g., physicists do.
No, but in a case like this our current POTUS might. Not right, but he might.
>> I can't believe I have to say this, but the POTUS is not some hacker news comment.
No, hes a guy charged with making high level decisions in a crisis. He also has some very competent advisors at places like the NIH, FDA, CDC etc... I dont think he was just some redneck responding to a tabloid article.
If the doctor now publicly claiming 699 treatments with 0 deaths using HCQ turns out to be a blatant fraud I think he may well lose his license given the situation.
But yeah, let's fuck around and try nothing and see how that goes.
No, hes a guy charged with making high level decisions in a crisis. He also has some very competent advisors at places like the NIH, FDA, CDC etc... I dont think he was just some redneck responding to a tabloid article.
If the doctor now publicly claiming 699 treatments with 0 deaths using HCQ turns out to be a blatant fraud I think he may well lose his license given the situation.
But yeah, let's fuck around and try nothing and see how that goes.
> If the doctor now publicly claiming 699 treatments with 0 deaths using HCQ turns out to be a blatant fraud
The odds seem good on that one.
"Zelenko’s claims, however, rest solely on taking him at his word: He has published no data, described no study design, and reported no analysis."
The odds seem good on that one.
"Zelenko’s claims, however, rest solely on taking him at his word: He has published no data, described no study design, and reported no analysis."
No one is saying try nothing. That is a bad faith argument. He is also incredibly poor at making good use those experts at the NIH, FDA, CDC, etc and and even poorer communicator of what those experts have to say.
> Their comments had already caused a shortage of HCQ
HCQ can only be obtained via a doctor's prescription. If there is a shortage of HCQ, its because actual physicians are writing it more, either for their own benefit or for their patients. This isn't the average person panic buying toilet paper. Its trained medical professionals. If you are implying that they are incapably of thinking rationally and professionally in response to a short, offhanded comment by the President, then the issue is far graver than anything Trump is saying.
> led to at least one death
Which occured because an elderly couple saw the news, realized that HCQ is in a chemical used to treat their fish tank, drank it, and one of them died. If I read an article saying a drinking alcohol in moderation can reduce heart disease, and in response I go out and chug a bottle of isopropyl alcohol, the consequences wouldn't be blamed on anyone but myself. If anything, it supports the idea that any partisanship in this situation is coming from those who are trying to pin every instance of something bad occurring, literally at the level of a single idiotic individual, on the POTUS.
HCQ can only be obtained via a doctor's prescription. If there is a shortage of HCQ, its because actual physicians are writing it more, either for their own benefit or for their patients. This isn't the average person panic buying toilet paper. Its trained medical professionals. If you are implying that they are incapably of thinking rationally and professionally in response to a short, offhanded comment by the President, then the issue is far graver than anything Trump is saying.
> led to at least one death
Which occured because an elderly couple saw the news, realized that HCQ is in a chemical used to treat their fish tank, drank it, and one of them died. If I read an article saying a drinking alcohol in moderation can reduce heart disease, and in response I go out and chug a bottle of isopropyl alcohol, the consequences wouldn't be blamed on anyone but myself. If anything, it supports the idea that any partisanship in this situation is coming from those who are trying to pin every instance of something bad occurring, literally at the level of a single idiotic individual, on the POTUS.
That's valid criticism, but it has nothing to do with partisanship.
The President shouldn't be recommending unproven drugs, he should be communicating what we know and what to do now.
But the president is not just a mouthpiece, he needs to make decisions based on incomplete information. His administration seems to have opened up channels for trials and off-label usage.
> off-label usage
Off-label usage is bad when this is a drug that other people (like those with lupus - see here [0]) need to survive - we need trials first and I'm not sure that is occurring due to the President. This is a problem created by too early messaging when you should be focusing on "stay home" and other clear communication that was absent for weeks before his focus on this drug.
[0]: https://www.cnn.com/2020/03/31/opinions/hydroxychloroquine-c...
Off-label usage is bad when this is a drug that other people (like those with lupus - see here [0]) need to survive - we need trials first and I'm not sure that is occurring due to the President. This is a problem created by too early messaging when you should be focusing on "stay home" and other clear communication that was absent for weeks before his focus on this drug.
[0]: https://www.cnn.com/2020/03/31/opinions/hydroxychloroquine-c...
It seems like this thread has evolved from (1) the president was partisan in his statements about HCQ; (2) the president was political in his statements about HCQ; to (3) he jumped the gun on messaging.
Let's not let the media tear us apart. Not everything is Trump's fault. Not everything is America's fault. And sometimes people who are not Trump or countries that are not America make bad decisions that cost lives. Let's acknowledge these basic facts and work together.
California and Texas seem to be making better choices than NY and Florida. America seems to be doing better than Italy and Spain but worse than Germany. It's not really a partisan thing and it's not really a national identity thing. It's an issue of who in what regions acted strongly enough, and when.
America is a federal system, so we would expect variance between the states, and that's what we're seeing. Same as in Europe. The federal government plays an important role (like preventing test kits from being developed outside the CDC -- bad -- and early travel restrictions -- probably good), but not the only role, and it shows.
Let's not let the media tear us apart. Not everything is Trump's fault. Not everything is America's fault. And sometimes people who are not Trump or countries that are not America make bad decisions that cost lives. Let's acknowledge these basic facts and work together.
California and Texas seem to be making better choices than NY and Florida. America seems to be doing better than Italy and Spain but worse than Germany. It's not really a partisan thing and it's not really a national identity thing. It's an issue of who in what regions acted strongly enough, and when.
America is a federal system, so we would expect variance between the states, and that's what we're seeing. Same as in Europe. The federal government plays an important role (like preventing test kits from being developed outside the CDC -- bad -- and early travel restrictions -- probably good), but not the only role, and it shows.
Yeah, I think it's not quite correct to say he made it partisan but he absolutely politicised the science here.
Welcome to the club. The over-the-top reactions to events like this are what's going to get this guy re-elected.
The difference is that Trump likes to promote himself in any way he can. So he hitched his wagon to CQ and HCQ before their true efficacy was known AND promoted it as a miracle cure before that was actually known. He later tempered his speech with "shows a lot of promise" but his initial statements basically said "if you can get your hands on it - you should get on it ASAP" which is irresponsible of the POTUS. He's not a medical expert, but he loves knowing things and regurgitating them to sound smart.
He wanted people (in case it panned out to be good) to attach his name to CQ and HCQ. That is selfish.
He wanted people (in case it panned out to be good) to attach his name to CQ and HCQ. That is selfish.
It absolutely did not.
The press did.
The mainstream US media has become a one-sided partisan cheerleading squad for the Democrats, and most Americans are sick of it. We'll see how that works out in November.
The press did.
The mainstream US media has become a one-sided partisan cheerleading squad for the Democrats, and most Americans are sick of it. We'll see how that works out in November.
> The mainstream US media has become a one-sided partisan cheerleading squad for the Democrats
They broadcast almost every word Trump says, largely uncritically[1], with frequent "Today is the day he became President" epiphanies whilst minor Democrat issues are blown up into huge talking points and controversies that last for months.
How the chuff are they a "one-sided partisan cheerleading squad" for the Democrats?
[1] There'll occasionally be a "these things aren't true" afterwards but it doesn't stop them broadcasting them first.
They broadcast almost every word Trump says, largely uncritically[1], with frequent "Today is the day he became President" epiphanies whilst minor Democrat issues are blown up into huge talking points and controversies that last for months.
How the chuff are they a "one-sided partisan cheerleading squad" for the Democrats?
[1] There'll occasionally be a "these things aren't true" afterwards but it doesn't stop them broadcasting them first.
Exactly. How is passing on information that had already been widely circulating among medical professionals making it partisan?
This is the one great thing about democracy: you choose exactly what you deserve.
Let's not jump the gun yet - not even been peer-reviewed.
I would argue that its being peer-reviewed as we speak. The typical peer-review process involves having other experts review the paper, for free, before publication. One small silver lining of this pandemic is the urgency has caused the scientific model to shift towards preprints, which are rapidly disseminated among the scientific community via places like Twitter and Reddit, and notable papers end up getting vetted by many, many more experts much more quickly than they would via the traditional process. I've already seen many flawed papers quickly debunked and shot down, and others quickly floated to the top of the discussion, via experts commenting on Twitter and elsewhere.
I wonder if after all this is over, if our methods of modern science are changed forever, or if we just revert to where we were before.
I wonder if after all this is over, if our methods of modern science are changed forever, or if we just revert to where we were before.
yepwewillsee(1)
Your bias is showing. I could say "most Americans are sick of a lying, inept administration that can't be trusted". But I would be accused of being a biased democrat. I suspect the reality is the administration is totally inept or rendered inept due to the rotten top. The misinformation or biased information on either side's media outlet does not let the people see the real truth. Strange times indeed.
Think about how silly that sounds - the MSM would need to coordinate their work, on a grand scale, to repeat the same messages about Trump and his people. They would have to coordinate their "fake news" (i.e. stuff that's critical of Trump) to all refer to the same facts. Seems like a lot of work to coordinate a destructive effort against the president AND keep it up over the last 3.5 years...
Face it, HCQ is an old and cheap drug that doesn't fit Big Pharma profit visions.
Its much more enticing for Big Pharma to sell new patented solutions, so they will pay their PR mouthpieces (MSM) to "be cautious" of anything that doesn't achieve that end goal.
Its much more enticing for Big Pharma to sell new patented solutions, so they will pay their PR mouthpieces (MSM) to "be cautious" of anything that doesn't achieve that end goal.
Haven’t many big pharmas pledged to or have donated millions of doses already?
Seems a bit in odds with your claims.
Seems a bit in odds with your claims.
Donate something that cost you 0.10 per pill and getting a tax write-off for $2.00 per pill. Sure, why not?
So... making those donations was bad? Would you prefer they not do it?
dont move the goalposts.
(1) OP said big pharma wants to downplay HCQ because it doesnt make them as much money.
(2) reply says that the fact that pharma donated millions of doses contradicts that
(3) OP counters that pharma is donating millions of doses because it gives them an epic tax write-off
it has nothing to do with donations being bad. it has to do with the fact that pharma is always doing whats best for them, and if its also best for patients that's a happy coincidence, but they frequently act in opposite of whats best for patients (e.g. price gouging on insulin, in this case possibly downplaying the efficacy of a cheap drug HCQ), and that's something we should notice and call out
(1) OP said big pharma wants to downplay HCQ because it doesnt make them as much money.
(2) reply says that the fact that pharma donated millions of doses contradicts that
(3) OP counters that pharma is donating millions of doses because it gives them an epic tax write-off
it has nothing to do with donations being bad. it has to do with the fact that pharma is always doing whats best for them, and if its also best for patients that's a happy coincidence, but they frequently act in opposite of whats best for patients (e.g. price gouging on insulin, in this case possibly downplaying the efficacy of a cheap drug HCQ), and that's something we should notice and call out
That’s fine however it doesn’t bode with the original assertion that it’s downplayed HCQ if anything it somewhat sensationalized it.
I have no problems believing that BigPharma does what is good for BigPharma in this case getting good PR, a tax write off and having their most valuable customers as in those with chronic conditions which means pretty much most people once they hit 50-60 to stay alive so they can sell their patented drugs to their insurers and HMOs is a much more believable strategy than some conspiracy that BigPharma is downplaying HCQ because they can’t make money on it.
I have no problems believing that BigPharma does what is good for BigPharma in this case getting good PR, a tax write off and having their most valuable customers as in those with chronic conditions which means pretty much most people once they hit 50-60 to stay alive so they can sell their patented drugs to their insurers and HMOs is a much more believable strategy than some conspiracy that BigPharma is downplaying HCQ because they can’t make money on it.
- I think Trump is the one who sensationalized it, not pharma surrogates, but I may be wrong
- I'm not committed to this particular conspiracy theory but I jumped in here because I don't like when people try to dismiss conspiracies out of hand as if it's crazy to think that pharma does things like this constantly. There's this free market ideology that exonerates companies and argues that self-interested behavior leads to positive outcomes, so I was reacting to what I sensed of that
- I'm not committed to this particular conspiracy theory but I jumped in here because I don't like when people try to dismiss conspiracies out of hand as if it's crazy to think that pharma does things like this constantly. There's this free market ideology that exonerates companies and argues that self-interested behavior leads to positive outcomes, so I was reacting to what I sensed of that
It’s perfectly acceptable to dismiss conspiracy theories that not only go against the actual narrative but against common sense.
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> dont move the goalposts.
Thought I was asking for clarification. What goalposts did I move?
Thought I was asking for clarification. What goalposts did I move?
[deleted]
> Face it, HCQ is an old and cheap drug that doesn't fit Big Pharma profit visions.
That seems like a non sequitur... Do you think HCQ knows that, and is therefore making itself less effective, just to stick it to Trump?
The reality is, HCQ is not without adverse side-effects, and we have reason to be cautious. There have been several examples in the past where early results of HCQ testing looked promising against various viruses, but didn't pan out when actually used at larger scale in humans.
That seems like a non sequitur... Do you think HCQ knows that, and is therefore making itself less effective, just to stick it to Trump?
The reality is, HCQ is not without adverse side-effects, and we have reason to be cautious. There have been several examples in the past where early results of HCQ testing looked promising against various viruses, but didn't pan out when actually used at larger scale in humans.
We can check efficacy claim of HCQ by doing Randomised trail in US under FDA supervision instead of just relying on Chinese studies, But main benefit of HCQ if it found to be effective would be that it is already a widely used approved drug. We know it's side effects, Getting a new drug approved and check for its side effects itself is very time consuming and expensive exercise. Here only randomised large scale trail is needed.
What is preventive USA Pharma companies and FDA to do randomised trails here ?
Nothing is preventing them, that is why there are several large scale trials taking place in the United States right now... (mostly in New York, as well as at least one in Washington).
That is not at all a fair assessment of what happened. I won't blame specific groups (there is plenty of fault to go around), but it wasn't the administration that made things partisan there.
The President literally called it a "Democrat hoax"
How is it not the administration's doing then?
How is it not the administration's doing then?
Snopes gave the claim a mixed rating because close reading of Trump's comments suggested to the article author that Trump was calling Democratic accusations of inadequate response by his administration the hoax, not the virus itself. The article is dated March 2.
But now it seems clear that the accusations were absolutely accurate, and the distinctions the author tries to draw are irrelevant.
But now it seems clear that the accusations were absolutely accurate, and the distinctions the author tries to draw are irrelevant.
The speech that you are referring to is unrelated to my comment.
I think Trump was just casting about for anything he might hitch his wagon to and claim credit for later. It's unfortunate that "the other side" heaped so much scorn on chloroquine just because Trump was touting it, because there was never any conclusive evidence that it doesn't work, and if it actually does work then they played right into Trump's usual "hoax" angle.
Agreed. But by trying to hitch their wagon to one particular treatment, and trying take ownership of that issue, they are making it about them and about politics rather than about the efficacy of the treatment.
In this kind of crisis, the last thing we need is to be injecting politics into the decision about which treatments are most effective.
In this kind of crisis, the last thing we need is to be injecting politics into the decision about which treatments are most effective.
"The other side" criticized Trump for what he said. They did not impugn the potential of chloroquine. This issue is only, "What did the president say and should he have said it".
No responsible person should offer unproven medical advice IN ANY WAY. And no medical professional should do so unless they have multiple reliables sources to support their advice.
Trump failed on both of these points. If chloroquine turns out to fail, he'll surely promote more possible treatments again and again, thereby whittling away public trust and hope, over and over. That's terrible leadership, and rightly merits criticism from everyone who gives a damn, not just "the other side".
No responsible person should offer unproven medical advice IN ANY WAY. And no medical professional should do so unless they have multiple reliables sources to support their advice.
Trump failed on both of these points. If chloroquine turns out to fail, he'll surely promote more possible treatments again and again, thereby whittling away public trust and hope, over and over. That's terrible leadership, and rightly merits criticism from everyone who gives a damn, not just "the other side".
"the other side" didn't say anything negative about CQ or HCQ - and instead (if you had actually listened to their message) tried to get people to NOT take it themselves, to NOT hoard it, to NOT prescribe it a prophylactic when that is an unknown (this depleting existing supplies).
That is what "the other side" was saying.
That is what "the other side" was saying.
We all saw the same news. The hammer has come down quite hysterically against chloroquine. Trump is usually a reliable liar: I presumed that journalists were banking on that fact and on disputing him as a safe way to get attention. And not doing their research.
Difficult to watch, as someone familiar with chloroquine, knowing they were spreading mistaken information about the side effects and blowing the risks well out of proportion.
Difficult to watch, as someone familiar with chloroquine, knowing they were spreading mistaken information about the side effects and blowing the risks well out of proportion.
I say you are wrong, though maybe this is the line we should be using if we still think we can tiptoe backwards out of Trump's chloroquine trap.
I repied to somebody saying essentially the same thing as you here: https://news.ycombinator.com/item?id=22760840
I repied to somebody saying essentially the same thing as you here: https://news.ycombinator.com/item?id=22760840
Look in the mirror to see how this became a partisan issue. The president made absolutely no partisan statements when mentioning his hope for the drug. It was those looking through dirt colored glasses that took things down that path.
It's not "partisan statements," it's the strategy of trying to take ownership of one particular treatment. It shouldn't be a political issue.
It's hard to see the president's statements as anything but an effort to promote himself by tying himself to this treatment. It should be non-partisan.
Previous administrations didn't try to set up "I win" scenarios in times of crisis. We need to be able to evaluate the treatment without it being clouded by the issue of whether one side or the other was right.
It's hard to see the president's statements as anything but an effort to promote himself by tying himself to this treatment. It should be non-partisan.
Previous administrations didn't try to set up "I win" scenarios in times of crisis. We need to be able to evaluate the treatment without it being clouded by the issue of whether one side or the other was right.
Trump's statements on the issue were completely out of all proportion to the current state of medical knowledge.
The UK government is led by a right wing populist by all accounts and this is what our daily breifing had to say on the matter "And in our determination to prevent as many patients as possible seeing their condition worsen we are conducting rapid clinical trials on those drugs, including anti-malarials, which may be able to reduce the impact of COVID-19 on those affected."
Contrast that with Trump's statements (by Twitter of course): "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)....."
If you can't see why there is a problem with the way Trump has spoken about these drugs then I'm afraid I've lost all hope.
The UK government is led by a right wing populist by all accounts and this is what our daily breifing had to say on the matter "And in our determination to prevent as many patients as possible seeing their condition worsen we are conducting rapid clinical trials on those drugs, including anti-malarials, which may be able to reduce the impact of COVID-19 on those affected."
Contrast that with Trump's statements (by Twitter of course): "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)....."
If you can't see why there is a problem with the way Trump has spoken about these drugs then I'm afraid I've lost all hope.
Trump: "This is their new hoax" - Their refers to Democrats and Hoax refers to the Coronavirus.
I'd say that's a pretty damn partisan statement from our Commander in Grief.
I'd say that's a pretty damn partisan statement from our Commander in Grief.
This really sounds like your bias showing. The media made this partisan, not the administration.
No. The administration made repeated wild unsubstantiated claims of a "cure" for a pandemic that the press properly pushed back on given the near zero experimental evidence behind the claim.
This issue is partisan only if partisans act unthinkingly. The press had damned good reason to act as it did. The 'administration' did not.
This issue is partisan only if partisans act unthinkingly. The press had damned good reason to act as it did. The 'administration' did not.
[deleted]
Based on this and all the other anecdotal studies plus all the people treated with it for other ailments, it seems fairly certain that at a minimum this treatment is not causing more harm. Given that plus all the indications that it seems to help to some degree, we should be pursuing production scale of these drugs aggressively.
It is very unfortunate that the media politicized this treatment in such a way that now everyone who dislikes Trump carries an initial bias against it.
It is very unfortunate that the media politicized this treatment in such a way that now everyone who dislikes Trump carries an initial bias against it.
I'm not american and i really, really don't care about trump now (i did in 2017 when i wanted an internship in Ohio that was denied cause new policies and all that stuff but i eventually found something better, so i'm not angry about it).
Antiviral drugs will always be given to late in this disease case, maybe it can reduce infectuosity but we don't know enough yet.
Maybe giving it to everyone to prevent the disease before its even there could be helpfull, but if i had to take HCQ, i will have to stop taking my antihistamine drugs, and going into april/may, this is a big no for me.
The fact that it can also reduce the autoimmune reaction is really interesting though, so maybe giving it to mild cases will prevent them to destroy their own cells, but this is also dangerous as the disease can cause myocard lesions (probably the autoimmune reaction, but we don't know yet).
In any case, talking about it is useless before more data arrive: even if we could give HCQ to everybody, the lockdown is still necessary until the first wave decrease (at least in France). Don't forge an opinion on something this early, it will be hard to let it go if you're wrong, and being right early don't give you anything.
Antiviral drugs will always be given to late in this disease case, maybe it can reduce infectuosity but we don't know enough yet.
Maybe giving it to everyone to prevent the disease before its even there could be helpfull, but if i had to take HCQ, i will have to stop taking my antihistamine drugs, and going into april/may, this is a big no for me.
The fact that it can also reduce the autoimmune reaction is really interesting though, so maybe giving it to mild cases will prevent them to destroy their own cells, but this is also dangerous as the disease can cause myocard lesions (probably the autoimmune reaction, but we don't know yet).
In any case, talking about it is useless before more data arrive: even if we could give HCQ to everybody, the lockdown is still necessary until the first wave decrease (at least in France). Don't forge an opinion on something this early, it will be hard to let it go if you're wrong, and being right early don't give you anything.
It's quite remarkable to see the media more focused on how they are supposed to oppose Trump rather than just reporting the news.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977261/