8 ms·

This is irresponsible. This drug has severe side effects, it makes absolutely no sense to prescribe it for a completely different disease without first confirmi

This is irresponsible. This drug has severe side effects, it makes absolutely no sense to prescribe it for a completely different disease without first confirming in clinical trials that it has positive effects. > if there's no suscipicion this drug could cause new problems, we should have people massively use it That's not how evidence-based medicine works. The drug is known to cause new problems because of the side effects. Clinical trials are needed to determine whether these are outweighed in patients by positive health effects. You do not prescribe medicine on the basis of hunches.

_red 7y ago
You are currently running another experiment called: Crash the global economy. That's also irresponsible. Should 10-yr olds be forced to give their life to save 85 yr olds?
- JoeAltmaier 7y ago
  Maybe a bit of strawman there. With more information (hopefully coming) we should be able to make more nuanced decisions.
ekianjo 7y ago
> This is irresponsible. This drug has severe side effects What are you talking about? The severe side effects are known and are usually associated with chronic usage of that drug. Chloroquine is taken for prophylaxis against malaria (daily) in many places in the southern hemisphere. Usual regimen is at least for 8 continuous weeks! EDIT: Toxicity here: as you can see it's very well tolerated. https://eyewiki.aao.org/Hydroxychloroquine_toxicity https://eyewiki.aao.org/Hydroxychloroquine_toxicity
- jonathanstrange 7y ago
  The suggestion on the table is to give this drug to extremely ill patients who suffer from a new viral disease on the basis of anecdotal evidence and without clinical trials. The suggestion was to massively prescribe it. What health authorities want to do is to allow physicians to use the drug if the patient agrees, but only in a controlled setting in which data is collected and there is a control group. So at least afterwards we could draw conclusions about whether it killed more people or helped saving people. Does that not make sense to you?
  - ignoramous 7y ago
    > Does that not make sense to you? It does, but why can't one can have the control groups at the same as blanket prescribtion? In times like this when the health care apparatus is overwhelmed, is it a good alternative to do that, since side effects are well-known and given the fact that the drug might be ineffective if used late in the infection cycle [0]? [0] https://news.ycombinator.com/item?id=22662849 https://news.ycombinator.com/item?id=22662849
  - chasil 7y ago
    There are actually several suggestions, which were repeatedly discussed a decade ago in multiple SARS studies (see my post below). First is prophylaxis for front line health care workers, who are suffering grave infections likely exacerbated by long hours and low morale. Long term use of chloroquine or alternatives is a concern for this audience. There were fatalities last time, just like this time. The second is for the patients themselves, who will otherwise endure uncontrolled viral replication for up to two weeks until the adaptive immune response recognizes the pathogen. Reducing transmission requires an earlier end to this stage. Is the data from the previous studies worthless for these goals?
  - bsaul 7y ago
    i absolutely don't see the need for a control group. We just need to monitor which patient had the treament and which didn't, globally. But if a doctor wants to prescribe all its patient with it, he should be allowed to, as long as it doesn't go against the traditional counter-indication for this very well known and very widely used on a global scale drug.
    - mbreese 7y ago
      > We just need to monitor which patient had the treament and which didn't, globally And you just described the reason for a control group. We simply do not have that information. Things are moving too fast and treatments have not been standardized yet, not to mention the built in variability between locations. If you want to know if a treatment is effective, you must have to comparable groups. The point of the control group is to gather that information. Just because there are many, many, global cases doesn’t mean you actually have been able to capture the data for a control. Things are moving that fast. > But if a doctor wants to prescribe all its patient with it, he should be allowed to And what about the supply of these drugs? There are people who do need these drugs for other conditions (I’ve read Lupus patients sometimes need it). These patients need the drug and the supply is getting scooped up by people who don’t know (a) if they have the virus and (b) if the treatment is effective. And if it is effective, is it effective for treatment of infection or prophylactically? Just because a drug is widely used does not mean that there is enough supply to distribute it to anyone who wants to try it. These are major issues that can be answered with proper clinical trials. We know how to do this and they can (and are) being done as fast as possible.
- tyingq 7y ago
  Worth noting the chloroquine and hydroxychloroquine have very different side effects and risks. Both have been debated as Covid-19 treatments.
- pnako 7y ago
  What is your expertise to discuss this issue? Are you a Python programmer? Do you even have an MBA? Did you sit through undergrad into to stats? If not, please let the experts from the University of Twitter and the Hacker News Clinic discuss those clinical tests.
  - taylodl 7y ago
    Exactly! The world needs fewer armchair doctors during this pandemic.
    - jcrubino 7y ago
      Then don't settle for any advice who can tell you to pop a pill.
  - gchamonlive 7y ago
    That is a fallacy right there, discredit the source of the argument instead of the argument itself. People should have the right to discuss things openly, even without credentials. They should not, however, actively act upon it causing actual harm. This is the realm of the specialists. As long as we have these distinctions, let people discuss.
    - sbuk 7y ago
      Trouble is opinions can take on a life of their own. Not everyone is sensible enough to read opinions as just that. A lot of these articles are written with a tone of authority; espessially the ones from data scienctists. Discussion is fine, but bear in mind that its adding to a lot of unecessary noise.
      - gchamonlive 7y ago
        You imply there is a necessary noise in the conversation. Who are we to define what credentials should be used to define what is noisy and what is not? I think the best way is to attack the argument itself, not where it is coming from. If the discourse become authoritative and biased, we shut it, disregard it pointing out the flaws. But we have to be careful not to be authoritative ourselves when we don't even give the chance for the writer to be wrong because he lacks the right credentials.
- mcguire 7y ago
  https://eyewiki.aao.org/Hydroxychloroquine_toxicity https://eyewiki.aao.org/Hydroxychloroquine_toxicity: "This article focuses upon hydroxychloroquine retinopathy." See https://www.drugs.com/sfx/hydroxychloroquine-side-effects.html#for-professionals https://www.drugs.com/sfx/hydroxychloroquine-side-effects.ht...
Erlich_Bachman 7y ago
If it was so severe, why isn't it protected by a prescription requirement everywhere around the world?
- Madmallard 7y ago
  Tons of dangerous drugs aren't.
- macinjosh 7y ago
  Because prescription regimes aren't in place to protect patients. That is simply a guise. They are in place to protect the health care system from liability and to cement market advantage to the entrenched pharma companies.
- throwaway2048 7y ago
  Because they need to be as widely available as possible for malaria prophylaxis, because Malaria is a disease with a devastatingly high mortality.
  - snowwrestler 7y ago
    Yes--in plain English, the trade-offs are different in different places. It's not a recreational drug so there is (usually) little risk it will get taken or abused unless it is really needed. That does not mean the drug has no risks and can be taken as a free-for-all. And it's not just for drugs. It's also why DDT continues used in some countries but is illegal in others.
Cthulhu_ 7y ago
> You do not prescribe medicine on the basis of hunches. Nor on the basis of panic; we should be able to manage this pandemic as long as people stick to the measures in place. Stay at home, limit your shopping, don't take the piss. I mean panic right now is causing more problems - e.g. hoarding and people trying to make a quick buck. This thing is mainly a big problem because people can't keep calm and rational. Or they think they're rational, as in, "I should buy enough toilet paper because I should stay indoors for a while".
- deelowe 7y ago
  How long is a while? What happens if our supply chain is impacted? Grocery stores are open now, but isn't it possible for there to be outbreaks in the stores? What will become of the economy if this continues? These are very real concerns for which no one has answers. People are stockpiling because of the uncertainty, which could be seen as a very rational stance in hindsight if this goes on for quite some time.
- deleted 7y ago
  [deleted]
sendben2 7y ago
> This drug has severe side effects To clarify, hydroxychloroquine has far fewer side effects than chloroquine.
jansan 7y ago
This was done with Lopinavir-Ritonavir, which is an HIV drug. Unfortunately it turned out to be ineffective: https://www.ncbi.nlm.nih.gov/pubmed/32187464 https://www.ncbi.nlm.nih.gov/pubmed/32187464
jetcata 7y ago
I would be worried about the ocular toxicity and ototoxicity side effects. I would only want this drug given to me if there was no hope of recovery.
- skellington 7y ago
  Those side effects are RARE in people who take hydroxychloroquine for DECADES. We're only talking about taking it for 5-10 days here. Advil has probably killed more people than hydroxychloroquine.
biolurker1 7y ago
The drug is used for ages in Africa without severe side effect and people are dying.
pbreit 7y ago
I'm not sure if any of what you wrote is accurate. The drug is 90 years old, has been used by millions, has relatively modest side effects, is relatively well-understood, has shown efficacy against coronavirus in vitro.
ping_pong 7y ago
Stop spreading misinformation. Hydroxycholoquine is very safe and is prescribed to lupus patients daily. The Korean recommended dose (400mg/day) is the same as what is prescribed to lupus patients. Chloroquine is a bit more dangerous, but only in high doses and over long periods of time. Patients would be on either for 10-20 days maximum which is much less than what it takes to be dangerous. Both are less toxic than Tylenol.

_red 7y ago

You are currently running another experiment called: Crash the global economy. That's also irresponsible. Should 10-yr olds be forced to give their life to save 85 yr olds?

JoeAltmaier 7y ago
Maybe a bit of strawman there. With more information (hopefully coming) we should be able to make more nuanced decisions.

ekianjo 7y ago

> This is irresponsible. This drug has severe side effects What are you talking about? The severe side effects are known and are usually associated with chronic usage of that drug. Chloroquine is taken for prophylaxis against malaria (daily) in many places in the southern hemisphere. Usual regimen is at least for 8 continuous weeks! EDIT: Toxicity here: as you can see it's very well tolerated. https://eyewiki.aao.org/Hydroxychloroquine_toxicity https://eyewiki.aao.org/Hydroxychloroquine_toxicity

jonathanstrange 7y ago
The suggestion on the table is to give this drug to extremely ill patients who suffer from a new viral disease on the basis of anecdotal evidence and without clinical trials. The suggestion was to massively prescribe it. What health authorities want to do is to allow physicians to use the drug if the patient agrees, but only in a controlled setting in which data is collected and there is a control group. So at least afterwards we could draw conclusions about whether it killed more people or helped saving people. Does that not make sense to you?
- ignoramous 7y ago
  > Does that not make sense to you? It does, but why can't one can have the control groups at the same as blanket prescribtion? In times like this when the health care apparatus is overwhelmed, is it a good alternative to do that, since side effects are well-known and given the fact that the drug might be ineffective if used late in the infection cycle [0]? [0] https://news.ycombinator.com/item?id=22662849 https://news.ycombinator.com/item?id=22662849
- chasil 7y ago
  There are actually several suggestions, which were repeatedly discussed a decade ago in multiple SARS studies (see my post below). First is prophylaxis for front line health care workers, who are suffering grave infections likely exacerbated by long hours and low morale. Long term use of chloroquine or alternatives is a concern for this audience. There were fatalities last time, just like this time. The second is for the patients themselves, who will otherwise endure uncontrolled viral replication for up to two weeks until the adaptive immune response recognizes the pathogen. Reducing transmission requires an earlier end to this stage. Is the data from the previous studies worthless for these goals?
- bsaul 7y ago
  i absolutely don't see the need for a control group. We just need to monitor which patient had the treament and which didn't, globally. But if a doctor wants to prescribe all its patient with it, he should be allowed to, as long as it doesn't go against the traditional counter-indication for this very well known and very widely used on a global scale drug.
  - mbreese 7y ago
    > We just need to monitor which patient had the treament and which didn't, globally And you just described the reason for a control group. We simply do not have that information. Things are moving too fast and treatments have not been standardized yet, not to mention the built in variability between locations. If you want to know if a treatment is effective, you must have to comparable groups. The point of the control group is to gather that information. Just because there are many, many, global cases doesn’t mean you actually have been able to capture the data for a control. Things are moving that fast. > But if a doctor wants to prescribe all its patient with it, he should be allowed to And what about the supply of these drugs? There are people who do need these drugs for other conditions (I’ve read Lupus patients sometimes need it). These patients need the drug and the supply is getting scooped up by people who don’t know (a) if they have the virus and (b) if the treatment is effective. And if it is effective, is it effective for treatment of infection or prophylactically? Just because a drug is widely used does not mean that there is enough supply to distribute it to anyone who wants to try it. These are major issues that can be answered with proper clinical trials. We know how to do this and they can (and are) being done as fast as possible.
tyingq 7y ago
Worth noting the chloroquine and hydroxychloroquine have very different side effects and risks. Both have been debated as Covid-19 treatments.
pnako 7y ago
What is your expertise to discuss this issue? Are you a Python programmer? Do you even have an MBA? Did you sit through undergrad into to stats? If not, please let the experts from the University of Twitter and the Hacker News Clinic discuss those clinical tests.
- taylodl 7y ago
  Exactly! The world needs fewer armchair doctors during this pandemic.
  - jcrubino 7y ago
    Then don't settle for any advice who can tell you to pop a pill.
- gchamonlive 7y ago
  That is a fallacy right there, discredit the source of the argument instead of the argument itself. People should have the right to discuss things openly, even without credentials. They should not, however, actively act upon it causing actual harm. This is the realm of the specialists. As long as we have these distinctions, let people discuss.
  - sbuk 7y ago
    Trouble is opinions can take on a life of their own. Not everyone is sensible enough to read opinions as just that. A lot of these articles are written with a tone of authority; espessially the ones from data scienctists. Discussion is fine, but bear in mind that its adding to a lot of unecessary noise.
    - gchamonlive 7y ago
      You imply there is a necessary noise in the conversation. Who are we to define what credentials should be used to define what is noisy and what is not? I think the best way is to attack the argument itself, not where it is coming from. If the discourse become authoritative and biased, we shut it, disregard it pointing out the flaws. But we have to be careful not to be authoritative ourselves when we don't even give the chance for the writer to be wrong because he lacks the right credentials.
mcguire 7y ago
https://eyewiki.aao.org/Hydroxychloroquine_toxicity https://eyewiki.aao.org/Hydroxychloroquine_toxicity: "This article focuses upon hydroxychloroquine retinopathy." See https://www.drugs.com/sfx/hydroxychloroquine-side-effects.html#for-professionals https://www.drugs.com/sfx/hydroxychloroquine-side-effects.ht...

Erlich_Bachman 7y ago

If it was so severe, why isn't it protected by a prescription requirement everywhere around the world?

Madmallard 7y ago
Tons of dangerous drugs aren't.
macinjosh 7y ago
Because prescription regimes aren't in place to protect patients. That is simply a guise. They are in place to protect the health care system from liability and to cement market advantage to the entrenched pharma companies.
throwaway2048 7y ago
Because they need to be as widely available as possible for malaria prophylaxis, because Malaria is a disease with a devastatingly high mortality.
- snowwrestler 7y ago
  Yes--in plain English, the trade-offs are different in different places. It's not a recreational drug so there is (usually) little risk it will get taken or abused unless it is really needed. That does not mean the drug has no risks and can be taken as a free-for-all. And it's not just for drugs. It's also why DDT continues used in some countries but is illegal in others.

Cthulhu_ 7y ago

> You do not prescribe medicine on the basis of hunches. Nor on the basis of panic; we should be able to manage this pandemic as long as people stick to the measures in place. Stay at home, limit your shopping, don't take the piss. I mean panic right now is causing more problems - e.g. hoarding and people trying to make a quick buck. This thing is mainly a big problem because people can't keep calm and rational. Or they think they're rational, as in, "I should buy enough toilet paper because I should stay indoors for a while".

deelowe 7y ago
How long is a while? What happens if our supply chain is impacted? Grocery stores are open now, but isn't it possible for there to be outbreaks in the stores? What will become of the economy if this continues? These are very real concerns for which no one has answers. People are stockpiling because of the uncertainty, which could be seen as a very rational stance in hindsight if this goes on for quite some time.
deleted 7y ago
[deleted]

sendben2 7y ago

> This drug has severe side effects To clarify, hydroxychloroquine has far fewer side effects than chloroquine.

jansan 7y ago

This was done with Lopinavir-Ritonavir, which is an HIV drug. Unfortunately it turned out to be ineffective: https://www.ncbi.nlm.nih.gov/pubmed/32187464 https://www.ncbi.nlm.nih.gov/pubmed/32187464

jetcata 7y ago

I would be worried about the ocular toxicity and ototoxicity side effects. I would only want this drug given to me if there was no hope of recovery.

skellington 7y ago
Those side effects are RARE in people who take hydroxychloroquine for DECADES. We're only talking about taking it for 5-10 days here. Advil has probably killed more people than hydroxychloroquine.

biolurker1 7y ago

The drug is used for ages in Africa without severe side effect and people are dying.

pbreit 7y ago

I'm not sure if any of what you wrote is accurate. The drug is 90 years old, has been used by millions, has relatively modest side effects, is relatively well-understood, has shown efficacy against coronavirus in vitro.

ping_pong 7y ago

Stop spreading misinformation. Hydroxycholoquine is very safe and is prescribed to lupus patients daily. The Korean recommended dose (400mg/day) is the same as what is prescribed to lupus patients. Chloroquine is a bit more dangerous, but only in high doses and over long periods of time. Patients would be on either for 10-20 days maximum which is much less than what it takes to be dangerous. Both are less toxic than Tylenol.