Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients(sciencedirect.com)
sciencedirect.com
Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients
http://www.sciencedirect.com/science/article/pii/S0924857920303423
109 comments
This seems like good news. Is hydroxychloroquine currently being prescribed widely?
> This seems like good news. Is hydroxychloroquine currently being prescribed widely?
Sort of. Since Trump tweeted and mentioned the drug, hydroxychloroquine has become politicized.
Some scientists and doctors say it might have some use.
But the media is critical of it because Trump mentioned it.
Sort of. Since Trump tweeted and mentioned the drug, hydroxychloroquine has become politicized.
Some scientists and doctors say it might have some use.
But the media is critical of it because Trump mentioned it.
Down voted for stating facts...
> But the media is critical of it because Trump mentioned it.
What an odd conclusion to draw.
I think it would be more accurate to say: Trump is being criticized for hyping a medication that has not yet undergone medical trials.
There's an established method for bringing medication to market. Trump is ignorant of that method. That's why he's being criticized.
What an odd conclusion to draw.
I think it would be more accurate to say: Trump is being criticized for hyping a medication that has not yet undergone medical trials.
There's an established method for bringing medication to market. Trump is ignorant of that method. That's why he's being criticized.
HCQ is not a new drug. It's widely available globally. It has been used as an antiviral therapeutic and to prevent malaria since the 50s or so.
Right, It's not a new drug, but its efficacy for treating COVID-19 has not been established. Using it to treat COVID-19 prior to completion of medical trials is premature and has the potential to cause more harm than good.
"widely available globally" and "has been used as an antiviral therapeutic" is not the correct criteria to use here.
"widely available globally" and "has been used as an antiviral therapeutic" is not the correct criteria to use here.
I suggest you try to get in touch with those people working in Asian sides using it as treatment. Most don't publish their results there but do use it. And you can see a significant low mortality compare to western countries that largely choose not to use it. South and Eastern Asian side has very high infection rates way more than western counterpart and yet mortality is significantly lower both in terms of absolute value or by percentage.
Off label uses of drugs has been common for decades. Trials aren't just spun up without some evidence of anecdotes to support them being worth the effort. If anything a drug with well understood side effects and a plausible method of actually being helpful is probably worth trying while formal trials can be conducted.
When you're dealing with a new disease there are no best practices for treatment. This is tautologically true. That's why doctors have to use their best judgement and try different things and write down what seems to work and what doesn't. Often they get it wrong, with very bad consequences. For instance putting covid patients prematurely on mechanical ventilators had catastrophic health implications. When this became apparent ventilator policy changed. People died and now we know better. It's ugly, but that's how you learn about treating a new(ish) disease. Waiting for the results of multiple randomized controlled trials is, frankly, fantasy. Covid has almost entirely ran its course and we aren't close to having solid treatment results from randomized controlled trials. Premature and ad-hoc treatment is how we've muddled through the pandemic, and it's how we'll muddle through the next pandemic, too.
> When you're dealing with a new disease there are no best practices for treatment.
That doesn't give you carte blanche to claim that your drug does wonderful things for condition X when the evidence supporting your claim is non-existent, extremely weak, or obviously fraudulent.
> That's why doctors have to use their best judgement and try different things and write down what seems to work and what doesn't.
Which is completely different to POTUS recommending HCQ because he or his friends have financial interest in a company that makes that drug.
It's also extremely negligent to try popularising a particular drug which is already in short supply and needed by people with existing life-threatening conditions. If something looks promising, you finance some trials to provide more certainty, and then you look at ways to ramp up production because you know demand is going to increase.
That doesn't give you carte blanche to claim that your drug does wonderful things for condition X when the evidence supporting your claim is non-existent, extremely weak, or obviously fraudulent.
> That's why doctors have to use their best judgement and try different things and write down what seems to work and what doesn't.
Which is completely different to POTUS recommending HCQ because he or his friends have financial interest in a company that makes that drug.
It's also extremely negligent to try popularising a particular drug which is already in short supply and needed by people with existing life-threatening conditions. If something looks promising, you finance some trials to provide more certainty, and then you look at ways to ramp up production because you know demand is going to increase.
Medical misinformation :
Malaria is caused by a parasite, not a virus. For Lupus or RA hydroxychloroquine helps through its anti-inflammatory and immunosuppressive properties.
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Hydroxychloroquine also directly inhibits heme breakdown, a weak point in malaria parasites' blood digestion.
Beyond its standard antiviral and immunomodulatory activity, it's thought that hydroxychloroquine protects red blood cells' heme molecules from having their iron ripped out by Covid.
Beyond its standard antiviral and immunomodulatory activity, it's thought that hydroxychloroquine protects red blood cells' heme molecules from having their iron ripped out by Covid.
it is unfortunately like that. Not just in US but in Brazil too. I don't know if it works. I don't like any politician. But it's true that both sides (left and right) are politicizing the drug.
A tableau:
Politician A does something outrageous for political gain. A's opponents in party B decry this outrageous action as being outrageous and done for political gain. Decrying things A does is to B's political advantage! Conclusions: everyone is politicizing this issue.
Maybe we need a better metric for evaluating political action than whether the actors see some political benefit.
Politician A does something outrageous for political gain. A's opponents in party B decry this outrageous action as being outrageous and done for political gain. Decrying things A does is to B's political advantage! Conclusions: everyone is politicizing this issue.
Maybe we need a better metric for evaluating political action than whether the actors see some political benefit.
It's such a pity how politicised hydroxychloroquine has become.
It's stupid to believe in miracle cures. But it's also stupid to discard out of hand things for which evidence is unclear just because your opponent is irrationally keen on it.
It's stupid to believe in miracle cures. But it's also stupid to discard out of hand things for which evidence is unclear just because your opponent is irrationally keen on it.
Yes, it would be stupid. But is that what's happening here?
You have a ton of studies that says "no" and a few that say "maybe". But you want us to what? Keep studying until it finally says "yes"?
"Check this out, it shows promise"
"Ok." "Oh, it's not as effective as initially thought"
"Ok, but this study says it might be"
"Ok, but we just did a full study that says it's not"
"Ok, but this study"
And on and on. At what point do you say, "Ok, I guess we should move on".
It was never discarded out of hand.
You have a ton of studies that says "no" and a few that say "maybe". But you want us to what? Keep studying until it finally says "yes"?
"Check this out, it shows promise"
"Ok." "Oh, it's not as effective as initially thought"
"Ok, but this study says it might be"
"Ok, but we just did a full study that says it's not"
"Ok, but this study"
And on and on. At what point do you say, "Ok, I guess we should move on".
It was never discarded out of hand.
In April, Dr Zelenco stated he had treated some 600 patients with HCQ+Zinc+Zpac with good results. And now more doctors are saying the same.
Not a single trial has tested this treatment. This is why people won’t give up hope. From my reading it seems to be Zpac that creates the most heart risk and doxycycline is now sometimes used instead.
Zithromax is an antibiotic. Which is useless against a virus.
And why are doctors giving untested treatments to patients?
And why are doctors giving untested treatments to patients?
To be clear, I think this is a pretty bad "study".
But there are plenty of reasons why antibiotics are given to people with Covid-19 to deal with secondary infections.
> And why are doctors giving untested treatments to patients?
This seems a pretty bad-faith comment. In the early days of COVID-19 there was no "tested" treatment, so doctors use reasoning to try to find something. This is a completely normal thing to do.
But there are plenty of reasons why antibiotics are given to people with Covid-19 to deal with secondary infections.
> And why are doctors giving untested treatments to patients?
This seems a pretty bad-faith comment. In the early days of COVID-19 there was no "tested" treatment, so doctors use reasoning to try to find something. This is a completely normal thing to do.
Throwing stuff at the wall and seeing what sticks is a good way to get people killed.
Doctors are not researchers and they shouldn't be.
It's not a bad-faith comment.
Doctors are not researchers and they shouldn't be.
It's not a bad-faith comment.
This is all news to the medical profession. They have always and are trained to deal with novel situations by trying treatments based on inferring likely response based in symptoms.
>Zithromax is an antibiotic. Which is useless against a virus.
"Azithromycin Induces Anti-Viral Responses in Bronchial Epithelial Cells" has over 220 citations. (https://pubmed.ncbi.nlm.nih.gov/20150207/)
"Azithromycin Induces Anti-Viral Responses in Bronchial Epithelial Cells" has over 220 citations. (https://pubmed.ncbi.nlm.nih.gov/20150207/)
Zelenco has been thoroughly disgraced for ethics violations. His work was so riddled with issues, that it was the subject of ridicule for weeks afterwards by legitimate scientists. It's not worthy of discussion in a good faith discussion on the efficacy of HCQ.
As far as I know this describes Dr Zelenco’s work.
Google turns up zero hits for review of this paper. This paper demonstrates efficacy for his treatment. If you have any links discrediting this work I would like to see a link. It is observational.
https://www.preprints.org/manuscript/202007.0025/v1
Dr. Zelenco was working with the FDA to get a trial of his protocol. The FDA director provided some help to get his trial started. The director got criticism for helping. Something about a small trial not being worth his time. I don’t know where this criticism/pressure came from. But this has politics written all over it.
Dr Zelenco made one mistake stating that he had FDA approval to run the trial. The truth is that he had his hospital approval. The district attorney was looking to prosecute him for this mistake. I believe it was a simple mistake. He is not versed in running trials. He was told his trial was approved. He failed to distinguish who made the approval. The DA getting involved is more politics. His trial never got run, probably because of DA pressure. I believe he is a good doctor and has not been discredited. Railroaded by politics more likely. You should be asking why no one wants to test HCQ+Zinc. Why is HCQ condemned without running this most obvious of necessary trials. Why is there no urgency to run a trial on HCQ+Zinc. Why is the media silent on the lack of Zinc in the trials. It might not work, but a trial is more than warranted.
He did one other thing I’m aware of which was to tell his community the current scientific projections of mortality of Covid19. Those projections have proven wrong, and his community blames the messenger.
Dr. Zelenco was working with the FDA to get a trial of his protocol. The FDA director provided some help to get his trial started. The director got criticism for helping. Something about a small trial not being worth his time. I don’t know where this criticism/pressure came from. But this has politics written all over it.
Dr Zelenco made one mistake stating that he had FDA approval to run the trial. The truth is that he had his hospital approval. The district attorney was looking to prosecute him for this mistake. I believe it was a simple mistake. He is not versed in running trials. He was told his trial was approved. He failed to distinguish who made the approval. The DA getting involved is more politics. His trial never got run, probably because of DA pressure. I believe he is a good doctor and has not been discredited. Railroaded by politics more likely. You should be asking why no one wants to test HCQ+Zinc. Why is HCQ condemned without running this most obvious of necessary trials. Why is there no urgency to run a trial on HCQ+Zinc. Why is the media silent on the lack of Zinc in the trials. It might not work, but a trial is more than warranted.
He did one other thing I’m aware of which was to tell his community the current scientific projections of mortality of Covid19. Those projections have proven wrong, and his community blames the messenger.
This is a much better and thorough critique than I could write up:
https://respectfulinsolence.com/2020/04/03/zelenko-smith-aba...
https://respectfulinsolence.com/2020/04/03/zelenko-smith-aba...
hhw says>"Zelenco[sic] has been thoroughly disgraced for ethics violations. "<
What ethics violations? Please provide a cite that says "Zelenko has been thoroughly disgraced for ethics violations" or even charged with any ethics violations. You're slandering him.
What ethics violations? Please provide a cite that says "Zelenko has been thoroughly disgraced for ethics violations" or even charged with any ethics violations. You're slandering him.
It was. Long before the bulk of the studies even processed, the media had flipped right over to "hcq is the devil and a hoax". This, from what I observed, was essentially independent of any actual scientific research or result.
The initial "hcq works" was also independent of any actual scientific research or result.
If someone says "Take this magical cure, maybe it could work... but I don't have any evidence of it yet", it's not so terrible to start from a position of skepticism. Could hcq work? Maybe, although with every randomized trial it seems less likely. But the people who initially pushed it did so from a position of wishful thinking, not actual science. This might have been a hoax of ignorance not evil, but in the end, I say it's still a hoax.
If someone says "Take this magical cure, maybe it could work... but I don't have any evidence of it yet", it's not so terrible to start from a position of skepticism. Could hcq work? Maybe, although with every randomized trial it seems less likely. But the people who initially pushed it did so from a position of wishful thinking, not actual science. This might have been a hoax of ignorance not evil, but in the end, I say it's still a hoax.
IvyMike says>The initial "hcq works" was also independent of any actual scientific research or result.<
No, there were Chinese, French and other reports and observational studies during the pandemic that supported use of HCQ:
>"Wuhan was the epicenter, and the Chinese physicians at the People’s Hospital of Wuhan University told their Western counterparts that they got the idea of using HCQ because none of the 178 patients they had admitted for COVID-19 had lupus—a surprise, since lupus is an immune disease, and some thought it might have made these patients especially vulnerable. They wondered why this might be, and whether HCQ, which these patients had been taking for this preexisting condition, might in some way be protecting them against COVID-19."<
taken from "Hydroxychloroquine: A Morality Tale":
https://www.tabletmag.com/sections/science/articles/hydroxyc...
No, there were Chinese, French and other reports and observational studies during the pandemic that supported use of HCQ:
>"Wuhan was the epicenter, and the Chinese physicians at the People’s Hospital of Wuhan University told their Western counterparts that they got the idea of using HCQ because none of the 178 patients they had admitted for COVID-19 had lupus—a surprise, since lupus is an immune disease, and some thought it might have made these patients especially vulnerable. They wondered why this might be, and whether HCQ, which these patients had been taking for this preexisting condition, might in some way be protecting them against COVID-19."<
taken from "Hydroxychloroquine: A Morality Tale":
https://www.tabletmag.com/sections/science/articles/hydroxyc...
The issue here isn't that one side was correct, or one side was wrong. The issue here is that both sides talking points were barely even touched the actual results. You're right, "hcq works" was independent of the scientific work done then. However, "HCQ doesn't work" was the same. The reason we had those studies in the first place is because preliminary work showed some promise, and researchers decided to dig in to confirm this. What many people don't know is that the biomedical scientific process is fraught with false starts and failures to replicate. The results are subsequently slow.
At that time, the only responsible answer, and the answer that any biomedical scientist with integrity would give is: "Early results show X, though further follow up studies would be needed to replicate these results to confirm their validity"
But that's not what we got. What we got was a binary split between miracle cure and worse than homeopathy, depending on which side of the political divide you were on.
At that time, the only responsible answer, and the answer that any biomedical scientist with integrity would give is: "Early results show X, though further follow up studies would be needed to replicate these results to confirm their validity"
But that's not what we got. What we got was a binary split between miracle cure and worse than homeopathy, depending on which side of the political divide you were on.
Both-sidism: in evidence-based medecine, a treatment is ineffective until it is proven effective.
Now that some monthes have passed, at least five peer-reviewed RCTs were conducted. In each of them hydroxychloroquine is ineffective.
Now that some monthes have passed, at least five peer-reviewed RCTs were conducted. In each of them hydroxychloroquine is ineffective.
> or one side was wrong
I argue that when someone declares, without evidence, that "X works", that is a hoax and should be criticized. Even if later evidence shows it works! Because it's easy to make a random guess, and it's hard to fight the collateral damage that wrong guess can cause.
There are a million things that might be the covid miracle cure (colloidal silver? high protein diet? grapeseed extract? etc, etc, etc). If I pick one of these on a hunch and start pushing it as a cure, I would rightly deserve to be called out.
I argue that when someone declares, without evidence, that "X works", that is a hoax and should be criticized. Even if later evidence shows it works! Because it's easy to make a random guess, and it's hard to fight the collateral damage that wrong guess can cause.
There are a million things that might be the covid miracle cure (colloidal silver? high protein diet? grapeseed extract? etc, etc, etc). If I pick one of these on a hunch and start pushing it as a cure, I would rightly deserve to be called out.
There was a (very bad!) study done in France that showed some initial promise which is what kicked off the whole thing.
Have you considered that maybe your observations are nowhere near complete enough to make a determination?
It's not really the media though. It's respected doctors and their ep·i·de·mi·ol·o·gy.
Trump isn't pushing sound science.
He's hoping to buffalo people (like you) into thinking he's on to something. AND THE MEDIA IS SO AGAINST HIM. EVEN THO IT REALLY HELPS THE FAKE NEWS JUST WANTS TO HURT HIM. BECAUSE THEY LOVE HILLARY
Trump isn't pushing sound science.
He's hoping to buffalo people (like you) into thinking he's on to something. AND THE MEDIA IS SO AGAINST HIM. EVEN THO IT REALLY HELPS THE FAKE NEWS JUST WANTS TO HURT HIM. BECAUSE THEY LOVE HILLARY
> At what point do you say, "Ok, I guess we should move on".
This is a weird question. By "we" do you mean the media or politicians or scientists?
Politician should not ever be making claims that aren't backed up by strong studies. It's fine to say "I'm hopeful this will prove useful" etc, but to advocate for treatment using unproven medicines is irresponsible.
The media has a pretty difficult job here. Medical studies (particularly early ones) on treatments are rarely decisive (because doctors are trying anything to save someone's life, and that creates co-founding factors. Generally trying for balance ("this is a good study with promising results. Others show different results, and the differences are X and Y. Specialist Dr ABC says "XXXX") is about the best someone can do.
Scientists should keep studying it until we understand what is causing the different responses.
This is a weird question. By "we" do you mean the media or politicians or scientists?
Politician should not ever be making claims that aren't backed up by strong studies. It's fine to say "I'm hopeful this will prove useful" etc, but to advocate for treatment using unproven medicines is irresponsible.
The media has a pretty difficult job here. Medical studies (particularly early ones) on treatments are rarely decisive (because doctors are trying anything to save someone's life, and that creates co-founding factors. Generally trying for balance ("this is a good study with promising results. Others show different results, and the differences are X and Y. Specialist Dr ABC says "XXXX") is about the best someone can do.
Scientists should keep studying it until we understand what is causing the different responses.
They've studied it enough to know that it doesn't have any appreciable effect.
To keep studying it would be to appease either the politicians or media.
In science, failure is actually an option.
To keep studying it would be to appease either the politicians or media.
In science, failure is actually an option.
> They've studied it enough to know that it doesn't have any appreciable effect.
Well results seem conflicted on this. This very study (the one linked here!, ie[1]) shows a significant result.
It's an observational study, but that is a normal part of the scientific process during medical research.
There are plenty of other studies showing no result. But this is hardly the only one showing positive results.
So I don't think the science is settled on this (and it would be astonishing if it was in the 4 months since this process started!). I think Trump's behaviour on this has been atrocious and has caused harm, but that doesn't mean anything regarding if it works or not.
[1] https://www.sciencedirect.com/science/article/pii/S092485792...
Well results seem conflicted on this. This very study (the one linked here!, ie[1]) shows a significant result.
It's an observational study, but that is a normal part of the scientific process during medical research.
There are plenty of other studies showing no result. But this is hardly the only one showing positive results.
So I don't think the science is settled on this (and it would be astonishing if it was in the 4 months since this process started!). I think Trump's behaviour on this has been atrocious and has caused harm, but that doesn't mean anything regarding if it works or not.
[1] https://www.sciencedirect.com/science/article/pii/S092485792...
What makes you think that is the case? You're politicizing it right now.
I was watching the Joe Rogan podcast, and one of his friends who had covid was asked by the doctor what his political leanings are, because some patients refuse to take HCQ because Trump said it was helpful.
Joe Rogan isn't the best example to base your political opinions. There are also serious safety issues:
https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...
https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...
Fewer votes against Trump unless, like good Democrats, they mail in all their ballots before they die!8-))
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In this case discard out of hand meant study far more than was necessary.
Indeed. Look at the convalescent plasma news. Numerous article pumping it up, then Trump makes his announcement and suddenly it's questionable. All from the same MSM newspaper.[1]
[1]https://twitter.com/SpoxHHS/status/1298001649798197248?s=20
[1]https://twitter.com/SpoxHHS/status/1298001649798197248?s=20
"scientists express doubts about coronavirus treatment touted as breakthough by Trump "
What is the problem with this Washington Post headlines? Didn't scientists express doubts about this treatment? Didn't Trump didn't tout is as breakthrough?
Also see.. FDA Walks Back Claim of Dramatic Benefit From Covid Therapy https://www.bloomberg.com/news/articles/2020-08-24/fda-trump...
Also see.. FDA Walks Back Claim of Dramatic Benefit From Covid Therapy https://www.bloomberg.com/news/articles/2020-08-24/fda-trump...
Did you look at the Tweet? 4 articles a few months back touting plasma as a promising therapy. All positive.
Trump mentions it and suddenly it’s the worst idea in the world.
I have zero problems with calling out Trump on his hyperbole. It's not helpful at all. But it would be nice if the MSM didn't bash things these previously praised just because Trump said something.
Trump mentions it and suddenly it’s the worst idea in the world.
I have zero problems with calling out Trump on his hyperbole. It's not helpful at all. But it would be nice if the MSM didn't bash things these previously praised just because Trump said something.
Doubts about the efficacy of convalescent plasma already started popping up before Trump started advocating for it, with many papers being published in June and July.
This fascinating article was posted on HN a few days ago:
https://news.ycombinator.com/item?id=24251718
It talks about the history of the HCQ debacle and in the process taught me quite a lot about medical study methodology/epistemology.
It talks about the history of the HCQ debacle and in the process taught me quite a lot about medical study methodology/epistemology.
It appears to, at one point, just as a sideline, sneer at those who assert that homeopathy is quackery. To at least my layman's mind, that considerably drops the credibility of anything else it says.
[deleted]
I looked for homeopathy in the article to understand what you were getting at. To disregard a long article such as this on one sentence doesn't seem fair.
The article if anything is about epistemology - so the sneer is in reference to doctors assuming they 'know' the only correct ways to draw conclusions (and the article did take a dark twist indeed referencing the opioid epidemic). As a layman though, I don't know what it is referring to about Europe's relationship to homeopathy. I would be curious for a more knowledgeable person to weigh in on that.
The article if anything is about epistemology - so the sneer is in reference to doctors assuming they 'know' the only correct ways to draw conclusions (and the article did take a dark twist indeed referencing the opioid epidemic). As a layman though, I don't know what it is referring to about Europe's relationship to homeopathy. I would be curious for a more knowledgeable person to weigh in on that.
Well, as I say, I am a layman. To a person like me, trying to judge from what I do know, that was a show-stopper.
1. Not a low dose (400mg/week should be enough from what I've read)
2. No mention of zinc supplements, which seems to be the key to make the Hydroxychloroquine effective
2. No mention of zinc supplements, which seems to be the key to make the Hydroxychloroquine effective
> No mention of zinc supplements, which seems to be the key to make the Hydroxychloroquine effective
Clearly not.
Clearly not.
To my knowledge there has not yet been a trial completed with HCQ+Zinc. There are several doctors stating positive observational results with HCQ+Zinc.
I’m waiting for this study to complete:
https://clinicaltrials.gov/ct2/show/NCT04370782
Zinc has antiviral properties. It has been shown to stop Sars Cov2 replication in-vitro. Cells limit their Zinc intake. HCQ facilitates Zinc getting into cells.
Zinc has antiviral properties. It has been shown to stop Sars Cov2 replication in-vitro. Cells limit their Zinc intake. HCQ facilitates Zinc getting into cells.
Yes, it's been amazing to me how nearly everyone with continuing interest in HCQ has emphasized Zinc as an important factor, while so many studies have ignored it: neither supplementing it nor even checking enrolled patients for zinc deficiencies (which may be especially prevalent in the aged or those with known Covid comorbidities).
So I'll see, for example, some otherwise-highly-credible UCSF researchers mention a bunch of evidence they think puts the potential of HCQ to help to rest, without any mention of Zinc considerations (even in passing, or to ridicule, or to share why they don't think the link credible). But even coincident upon the very 1st discussions of HCQ as having potential, Derek Lowe shared an anecdote about how carrying-Zinc seemed essential to Chloroquine-related-compoounds' bioactivity (https://blogs.sciencemag.org/pipeline/archives/2020/03/20/ch...).
And, in many parts of the world, HCQ – as a cheap drug that, in moderate doses with proper monitoring, is very low-risk – is already considered part of the Covid-19 "standard-of-care". So, it's given even to the 'control' arms of trials for other compounds – making both its effects, and those other compounds' effects, harder to disentangle.
All I want now is true randomized trials - and can't at least one of those monitor, or vary the supplementation of, Zinc as well?
So I'll see, for example, some otherwise-highly-credible UCSF researchers mention a bunch of evidence they think puts the potential of HCQ to help to rest, without any mention of Zinc considerations (even in passing, or to ridicule, or to share why they don't think the link credible). But even coincident upon the very 1st discussions of HCQ as having potential, Derek Lowe shared an anecdote about how carrying-Zinc seemed essential to Chloroquine-related-compoounds' bioactivity (https://blogs.sciencemag.org/pipeline/archives/2020/03/20/ch...).
And, in many parts of the world, HCQ – as a cheap drug that, in moderate doses with proper monitoring, is very low-risk – is already considered part of the Covid-19 "standard-of-care". So, it's given even to the 'control' arms of trials for other compounds – making both its effects, and those other compounds' effects, harder to disentangle.
All I want now is true randomized trials - and can't at least one of those monitor, or vary the supplementation of, Zinc as well?
A subgroup analysis by self-reported zinc usage was done in the post-exposure prophylaxis RCT . No effect.
https://twitter.com/methodsmanmd/status/1293350242310590464
https://twitter.com/methodsmanmd/status/1293350242310590464
In vitro means a petri dish. Bleach has antiviral properties in those conditions.
In vitro results are much less meaningful than in vivo results. It can be a useful early validation step, but is far from telling us anything about real world efficacy.
There's enough in vivo studies at this point that in vitro studies should no longer be part of the conversation.
In vitro results are much less meaningful than in vivo results. It can be a useful early validation step, but is far from telling us anything about real world efficacy.
There's enough in vivo studies at this point that in vitro studies should no longer be part of the conversation.
[deleted]
I'm unfortunately completely unprepared to read a study like this and criticize it, but I do think that there's reason to believe the effect is close to zero. Why? Because more than one randomized controlled trial have produced zero effects compared to placebo.
https://www.washingtonpost.com/health/2020/07/16/hydroxychlo...
https://www.washingtonpost.com/health/2020/07/16/hydroxychlo...
I have no idea if hcq is effective, but I'm not sure that study you linked was meaningful.
FTA "The first randomized clinical trial testing hydroxychloroquine as an early treatment for mild covid-19 found the drug was no better than a placebo in patients who were not hospitalized."
So, maybe hcq has no effect on outcomes on mild cases. This does not mean it couldn't have an effect on severe/hospitalized patients.
FTA "The first randomized clinical trial testing hydroxychloroquine as an early treatment for mild covid-19 found the drug was no better than a placebo in patients who were not hospitalized."
So, maybe hcq has no effect on outcomes on mild cases. This does not mean it couldn't have an effect on severe/hospitalized patients.
It might be telling that the article linked to two separate studies?
I'm not sure if you read the whole article.
I'm not sure if you read the whole article.
I did.
The other study is similar in design.
FTA "The new study was a companion to a randomized trial by the same researchers published last month. Those results showed the drug is not effective in preventing covid-19 in healthy people exposed to the coronavirus."
The other study is similar in design.
FTA "The new study was a companion to a randomized trial by the same researchers published last month. Those results showed the drug is not effective in preventing covid-19 in healthy people exposed to the coronavirus."
> So, maybe hcq has no effect on outcomes on mild cases. This does not mean it couldn't have an effect on severe/hospitalized patients.
Sure, but that's the exact opposite of the earlier narrative when the trials in Brazil were called off.
(paraphrasing) "Sure, it doesn't help people who are critically ill, but you should use it as a prophylactic to prevent milder cases from becoming more severe".
So... it doesn't work in patients with a mild, moderate or severe case; (per the earlier advice) it must be prescribed after infection but before symptoms develop; and it must be prescribed in doses that are known to cause heart problems in a significant portion of the population (so significant, in fact, that patients prescribed much lower doses of HCQ are normally required to be regularly monitored for the onset of said problems).
At what point do you admit that any positive effect of HCQ is just cherry-picking/p-value-hacking?
Sure, but that's the exact opposite of the earlier narrative when the trials in Brazil were called off.
(paraphrasing) "Sure, it doesn't help people who are critically ill, but you should use it as a prophylactic to prevent milder cases from becoming more severe".
So... it doesn't work in patients with a mild, moderate or severe case; (per the earlier advice) it must be prescribed after infection but before symptoms develop; and it must be prescribed in doses that are known to cause heart problems in a significant portion of the population (so significant, in fact, that patients prescribed much lower doses of HCQ are normally required to be regularly monitored for the onset of said problems).
At what point do you admit that any positive effect of HCQ is just cherry-picking/p-value-hacking?
> So, maybe hcq has no effect on outcomes on mild cases.
Mild cases in people who work high-risk jobs and were selected away if they're immunocompromised or especially susceptible to infectious disease.
This is a totally different, "cherry-picked" sample set than your average populace with diverse immune health.
Mild cases in people who work high-risk jobs and were selected away if they're immunocompromised or especially susceptible to infectious disease.
This is a totally different, "cherry-picked" sample set than your average populace with diverse immune health.
Look at how that Minnesota randomized trial measured symptoms in mild Covid patients--it didn't comprehensively measure discomfort at all, and questionnaires were noisy data sources. The Spanish trial referenced took too long to give people hydroxychloroquine.
My experience with becoming infected with covid-19 and taking Hydroxychloroquine, azithromycin, and Zinc sulphate for five days was positive. My total time to recover from first sign of symptoms to becoming healthy again was about 11 days. I obviously can't and therefore won't make any claims that my experience is the direct result of taking those medications.
Here's a tracker that lists studies: https://c19study.com/
Here's a tracker that lists studies: https://c19study.com/
Well, your single personal experience can't be a proof of what treatment is working. Even more when we know that you had a 99% chance of recovering
Seems like your symptom resolution was about the median for most patients infected with covid.
http://cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm
http://cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm
How did it compare to the other time you got COVID-19 and didn't take HCQ/AZT/Zn?
You personal experience, despite being very important to you, isn't significative as scientific proof.
The site you mentioned is anonymous, a collection of links with arbitrary ratings. This isn't a scientific paper, this is marketing.
Here is a real meta-analysis for the different covid-19 treatments:
https://www.bmj.com/content/370/bmj.m2980
In 100% of randomized controlled trials, the most significant kind of scientific evidence, hydroxychloroquine is ineffective.
https://threadreaderapp.com/thread/1291068395497062400.html
Thanks for the meta-analysis link! Looking at the other measures, it does mention HCQ in duration of symptoms.
> Hydroxychloroquine might be the most effective in reducing the duration of symptoms. Remdesivir has intermediate effectiveness and lopinavir-ritonavir could have intermediate effectiveness. The main limitations of the evidence are risk of bias and imprecision.
> Hydroxychloroquine might be the most effective in reducing the duration of symptoms. Remdesivir has intermediate effectiveness and lopinavir-ritonavir could have intermediate effectiveness. The main limitations of the evidence are risk of bias and imprecision.
Yes mean difference −4.5 days,with a low certainty.. They also say:
Hydroxychloroquine might increase the risk of adverse events compared with the other interventions
And no evidence for reduction in death, except for glucocorticoids..
I would expect an effective treatment to reduce mortality..
No harm in taking these drugs even if you doubt the studies. The number of patients that have 'recovered' from COVID19 but are suffering long term debilitating effect is very scary. These drugs/minerals are been consumed by millions of people but little side effects before COVID. At best, it's somewhat effective; at worst, it's usefulness.
Not a randomized trial. In fact:
> Several comorbidities were significantly less frequent in the HCQ group, including cardiovascular diseases, arterial hypertension, chronic renal disease, neurological and cognitive disorders, solid cancer, obesity as well as the proportion of active smokers.
IOW, doctors gave HCQ to healthier people, so you can't conclude much from the death rate being lower. There may be some value in this paper if you really dig into the details, but the overall death rate isn't a meaningful indication of whether HCQ helps.
> Several comorbidities were significantly less frequent in the HCQ group, including cardiovascular diseases, arterial hypertension, chronic renal disease, neurological and cognitive disorders, solid cancer, obesity as well as the proportion of active smokers.
IOW, doctors gave HCQ to healthier people, so you can't conclude much from the death rate being lower. There may be some value in this paper if you really dig into the details, but the overall death rate isn't a meaningful indication of whether HCQ helps.
Plus once they adjusted for the multiple variables the effect is not huge. This will probably be more valuable in a much larger meta-analysis.
Not disagreeing with you, but you should probably include the next sentence:
> patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels.
But yes, it does not look good for this study that the HCQ group tended to be younger and healthier.
> patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels.
But yes, it does not look good for this study that the HCQ group tended to be younger and healthier.
And the VA observational study showing no HCQ benefit had the opposite problem, with those given HCQ much worse on many markers-of-health.
Non-randomized studies have wasted a lot of everyone's attention on this & related issues.
Non-randomized studies have wasted a lot of everyone's attention on this & related issues.
It's difficult (nigh impossible) to do a proper controlled and randomized trial during a pandemic. We wont see any definitive science done this year.
Thankfully, the UK went ahead and carried out a large-scale randomized controlled trial in the middle of the pandemic anyway despite the difficulty - otherwise we'd all be completely in the dark. Unfortunately, we seem to be pretty much the only country which did, which means that the evidence available is limited to the treatment and dosage combinations that happened to be included in that trial.
At least five peer-reviewed RCTs were published, more are on their way..Each of them negative.
Science was done.
The RECOVERY study on hydroxychloroquine was a randomised clinical trial from the UK with a large number of participants and concluded hydroxychloroquine had no clinical benefit:
> "A total of 1542 patients were randomised to hydroxychloroquine and compared with 3132 patients randomised to usual care alone. There was no significant difference in the primary endpoint of 28-day mortality (25.7% hydroxychloroquine vs. 23.5% usual care; hazard ratio 1.11 [95% confidence interval 0.98-1.26]; p=0.10). There was also no evidence of beneficial effects on hospital stay duration or other outcomes."
The press release from June: No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19
https://www.recoverytrial.net/news/statement-from-the-chief-...
> "A total of 1542 patients were randomised to hydroxychloroquine and compared with 3132 patients randomised to usual care alone. There was no significant difference in the primary endpoint of 28-day mortality (25.7% hydroxychloroquine vs. 23.5% usual care; hazard ratio 1.11 [95% confidence interval 0.98-1.26]; p=0.10). There was also no evidence of beneficial effects on hospital stay duration or other outcomes."
The press release from June: No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19
https://www.recoverytrial.net/news/statement-from-the-chief-...
> doctors gave HCQ to healthier people
It would be interesting to see someone build an IPTW model to estimate the average treatment effect of HCQ in all these non-randomized studies. My guess is that the effect would be statistically indistinguishable from zero.
It would be interesting to see someone build an IPTW model to estimate the average treatment effect of HCQ in all these non-randomized studies. My guess is that the effect would be statistically indistinguishable from zero.
>>> Several comorbidities were significantly less frequent in the HCQ group, including cardiovascular diseases, arterial hypertension, chronic renal disease, neurological and cognitive disorders, solid cancer, obesity as well as the proportion of active smokers.
>IOW, doctors gave HCQ to healthier people,
Literally the sentence after the one you quoted contradicts clarifies, though:
>> On the other hand, at admission, patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels.
>IOW, doctors gave HCQ to healthier people,
Literally the sentence after the one you quoted contradicts clarifies, though:
>> On the other hand, at admission, patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels.
I wouldn't call that a contradiction or clarification. It's yet another confound and there's no reason to believe it cancels out the other ones.
In this case, people arriving sicker at the hospital with a given disease is not necessarily an indication of the likelihood of death with no treatment. For instance, robust young people may wait until they are extremely sick before heading to the hospital, while old or immunocompromised people may go at the first sign of illness. In that case, you would expect death rate to be negatively correlated with how sick people are when they arrive at the hospital.
In this case, people arriving sicker at the hospital with a given disease is not necessarily an indication of the likelihood of death with no treatment. For instance, robust young people may wait until they are extremely sick before heading to the hospital, while old or immunocompromised people may go at the first sign of illness. In that case, you would expect death rate to be negatively correlated with how sick people are when they arrive at the hospital.
https://c19study.com/
This site has a good summary of all the studies that have been done on HCQ treatment of Covid-19.
This site has a good summary of all the studies that have been done on HCQ treatment of Covid-19.
This is a collection of links with arbitrary ratings from anonymous authors. A propaganda piece.
Here is a real meta-analysis..
https://www.bmj.com/content/370/bmj.m2980
What makes you say the ratings are arbitrary? Can you point to any of the papers in which the rating is out of sync with the conclusion of the linked paper?
No methodology, anonymous authors, no peer-reviewing, related to the account @covidanalysis, which is known to push pro-hcq propaganda..
Are you kidding? Why should we waste time with this propaganda piece while there are real scientific papers available?
No methodology, anonymous authors, no peer-reviewing, related to the account @covidanalysis, which is known to push pro-hcq propaganda..
Are you kidding?
Some smart French guy debunked this site https://threadreaderapp.com/thread/1284493669895041024.html And c19trials, another disinformation piece from the same authors.. https://threadreaderapp.com/thread/1291126570392924160.html
Some smart French guy debunked this site https://threadreaderapp.com/thread/1284493669895041024.html And c19trials, another disinformation piece from the same authors.. https://threadreaderapp.com/thread/1291126570392924160.html
I'm not sure what you're saying. Every paper has named authors listed next to it. And it explicitly states which ones have been peer-reviewed and which haven't (most, but not all, have been). Clicking through gets you full papers in the medical journals they were published in which includes the methodology.
Please tell me who are the authors of the website you mentioned and tell me what is the methodology they used for selecting the studies and rating them.
I think that's a somewhat valid criticism.
However, everything the site claims is something that you can verify for yourself by simply clicking the links they offer. This doesn't account for studies that should be in this list, but aren't. I'd be interested in hearing about which studies those are.
I think given that Doctors such as Simone Gold are being fired simply for stating that there's scientific evidence that HCQ can treat Covid-19 it's somewhat expected that sites such as this will be done anonymously.
I think given that Doctors such as Simone Gold are being fired simply for stating that there's scientific evidence that HCQ can treat Covid-19 it's somewhat expected that sites such as this will be done anonymously.
Where was Simone Gold fired from? If you look at her LinkedIn profile she is working as a concierge physician for 9 years, she worked as a congressional fellow.. never worked as an emergency physician. Claiming to have been fired is part of her whistle-blower narrative..
https://www.linkedin.com/in/simone-gold-md-jd-4636a87
Only a fool or someone just looking for confirmation would take an anonymous sham of meta-analysis seriously.
Only a fool or someone just looking for confirmation would take an anonymous sham of meta-analysis seriously.
[deleted]
Group treated with HCQ much younger and healthier..Study published in a paper were the editor-in-chief works for Raoult Institute..more of less self-publishing..
This is an obversational retrospective study.. Hydroxychloroquine is ineffective 100% of peer-reviewed randomized controlled trials,which is much more significative evidence..
This is an obversational retrospective study.. Hydroxychloroquine is ineffective 100% of peer-reviewed randomized controlled trials,which is much more significative evidence..
> Group treated with HCQ much younger and healthier..
Younger and sicker, actually:
>> patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels.
Younger and sicker, actually:
>> patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels.
Healthier as less comorbidites..
Why this kind of lie keeps up?
I'm sure people are going to find some link between sciencedirect.com and the Trump administration so we can ignore it, since it doesn't fit with our worldview of Orange Man Bad