10 ms·

Hydroxychloroquine Probably Isn’t the Answer

mrfusion 7y ago
I think this drug has become too politicized to be able to have a factual scientific debate.
- deleted 7y ago
  [deleted]
- abnry 7y ago
  Which is really, really a shame.
- jkachmar 7y ago
  You are commenting on an article that is nearly as apolitical as I can imagine one being to say that politicization of this topic makes it impossible to have a debate rooted in science. Isn’t this precisely an injection of politicization into a summary of scientific work?
- shripadk 7y ago
  Exactly! On one hand some scientists swear by these drugs and on the other hand other scientists are opposing it. It is science after all. It either works or it doesn't. There is no "probably isn't the answer" in this. It is almost like Big Pharma is fighting out their battles through these scientists.
  - gpm 7y ago
    > It either works or it doesn't. No, not really. What the criteria for starting/stopping treatment are (e.g. is it being given to early or late stage patients), what other treatments/drugs are also used, what dosage is used, etc can all effect this.
- brmgb 7y ago
  It's really a shame the whole world stops at the border of the USA so there is no other place this debate could happen.
  - justin66 7y ago
    I'm grimly curious, are the Rupert Murdoch media outlets overseas pushing these drugs as enthusiastically as they're doing here in the US?
  - makomk 7y ago
    Unfortunately, while the whole world doesn't stop at the borders of the USA, neither does the political bullshit eminating from it. All the claims about what's effective or ineffective as a solution to Covid-19 that politicians and journalists latch onto for political reasons leech out into the rest of the world and cause trouble there too.
- jacquesm 7y ago
  "If there was any effect of this drug on COVID-19, it was minimal. Hydroxychloroquine, whose toxicity is far lower, may be safer than chloroquine. But that doesn't matter if the drugs are ineffective." What's political about that? The whole idea that if there were a simple and cheap cure that it would be politicized to the point where it won't see widespread application is ridiculous.
  - shripadk 7y ago
    > What's political about that? Then why does the title say that Hydroxychloroquine "probably" isn't the answer? It either works or it doesn't. If the drugs are ineffective just say so. Why beat around the bush with a "probably"?
    - deleted 7y ago
      [deleted]
    - jacquesm 7y ago
      Probably as in 'not yet 100% sure'. As a measure of probability based on available evidence.
      - Natsu 7y ago
        To me, the headline reads like it's saying "this probably won't work" rather than "we don't yet have enough evidence to say that this works." If I had to headline this article, I probably would have written something like "Hydroxychloroquine data still inconclusive, don't get your hopes up yet" to better convey the meaning. From reading it, what the article actually supports is that we have seen two trials that are inconclusive. This is the meat of it in my view - == A French study of HCQ suggested that it had was effective in decreasing the viral load from nasal secretions. When azithromycin was added the magnitude of the effect was larger. [...] And a Chinese study of 30 patients doesn't prove that HCQ worked. Or that it doesn't. But the two groups, control and treated, showed no difference in the amount of virus in the throat on day seven, the length of time for the fever to go away. There was an apparent difference in the progression of the infection (determined by x-ray), in the two groups but this means little since 5/15 treated patients got worse vs. 7/15 in the control group. This effect could easily be by chance and nothing to do to the drug. Furthermore, this trial did not include azithromycin, so it cannot be compared to the French trial.
- justin66 7y ago
  Someone went really nuts with flagging and downvoting these comments.
  - mrfusion 7y ago
    Yeah this was up to +6 for a while. Pretty bizarre.
ysleepy 7y ago
If it would have situation altering effects we would already know. Huge effects would have been seen very early in the wide spread application of it.
- Ozzie_osman 7y ago
  I'm not so sure. Let's say it halves the number of deaths or halves the time it takes for someone to get better. But also it requires a certain dose to be most effective. How would you know in this fog of war? You'd still have many patients who are sick or dying. The whole point of this article is that it's really hard to know without controlled, randomized trials. And I agree.
  - ysleepy 7y ago
    Sure, but more so than all the other drugs? People just have a problem with a no-information-yet state, they'd rather talk about the unfounded rumor than acknowledge that people are hard at work and there is no definitive news yet.
- pbreit 7y ago
  Not necessarily. There are still a few variables like when it is offered, what drug combinations, comorbidities, dosage, etc.
williesleg 7y ago
Of course it is. People just have Trump Derangement Syndrome and it's clouding their judgment. Get over it. Or not. Hey, in fact, if not, just don't take it. One less libtard voter.
logicbombr 7y ago
Prevent Senior in Brazil, an health operator with mosts of its patients on risk groups (60+ yo) are using hydroxychloroquine on all its COVID-19 patients with tremendous success. Right now I choose to believe on MD in front line rather then in Health Societies, FDA, WHO and those bureaucrats who let the virus spread all around due to its incompetence
- hprotagonist 7y ago
  as we say on the internet, [citation needed]
- jacquesm 7y ago
  Do you have a reference for this?
  - Neekerer 7y ago
    He heard it from someone on the internet
  - andrenth 7y ago
    This local news article (in Portuguese) has quotes from Prevent Senior executives: https://www.diariodaregiao.com.br/_conteudo/2020/04/cidades/saude/1190185-medicos-relatam-sucesso-no-uso-da-hidroxicloroquina-em-pacientes-com-covid-19.html https://www.diariodaregiao.com.br/_conteudo/2020/04/cidades/... “Every patient showing symptoms and with CTs indicating the presence of Covid-19 are invited to join the protocol. We’ve discharged more than 200 patients”.
  - logicbombr 7y ago
    You can use Google Translate https://www.google.com.br/amp/s/noticias.uol.com.br/saude/ultimas-noticias/redacao/2020/03/23/prevent-senior-usa-cloroquina-em-todos-os-pacientes-com-coronavirus.amp.htm https://www.google.com.br/amp/s/noticias.uol.com.br/saude/ul... Hospitals like Albert Einstein and Sirio Libanês are also using it but patients must sign a term and take full responsibility over any complications.
- greatjack613 7y ago
PragmaticPulp 7y ago
Collectively, we need to get over the idea of all-or-nothing solutions to Coronavirus. We're not going to wake up one day with a "cure" for COVID-19. No one in the medical field actually expects Hydroxychloroquine to produce miraculous recoveries at this point. The idea is that any treatment that slows the progress of the infection will also buy the patient's immune system more time to fight the infection. If we can push the peak symptoms back even 1-2 days relative to untreated individuals, that gives the immune system that much extra time to mount an effective defense against the virus. When we finally confirm which treatments, if any, are useful for slowing the progress of the infections, we can combine them with earlier testing and identification to help reduce the number of patients who require hospitalization. It won't look like a cure, but it will be making improvements in treatment outcomes and reducing the burden on hospitals. At this scale, a small modification of disease severity can still be useful for minimizing the burden on hospitals, even if it doesn't fit the narrative of a miracle cure.
- gus_massa 7y ago
  > The idea is that any treatment that slows the progress of the infection will also buy the patient's immune system more time to fight the infection. Is there any serious trial that shows that Hydroxychloroquine has any effect at all?
  - Mountain_Skies 7y ago
    Double blind peer reviewed trials are a good goal but in the middle of a crisis you can't let a desire for perfection get in the way of the good. There is enough imperfect evidence that this treatment stack (that is, several drugs used in combination with hydroxychloroquine) has benefits that it should be considered a potential part of a solution. Waiting a couple of years for perfect studies to be carefully conducted is waiting until the crisis is over and the treatment moot. What is well known are the side effects of this drug, their likelyhood, and how to ameliorate them.
    - gus_massa 7y ago
      > There is enough imperfect evidence that this treatment stack [...] has benefits that it should be considered a potential part of a solution. Is there any evidence? Do you have a link to the best evidence so far? Did someone tried a similar treatment and get the same result? It is not necessary to have a perfect study, because there too little time. But how hard is to make a study with a randomized control group? You are not sure if this drug is better or worse, so giving only the standard treatment perhaps is better. I guess a double blind experiment is more difficult for logistic reasons, but if the patients have respirators and are sedated, it is almost a single blind experiment. And if the results are the number of death or an analysis in a lab by a machine (instead of self reports), they can be less influenceable.
stri8ed 7y ago
Not to diminish the possible successes, but without a randomized control trial, there is no way the success can reliably be attributed to the medications. That's not to say they should stop prescribing it, simply due to lack of formal trials. But the perceived benefits should not be taken at face value, yet.
- hexl 7y ago
  > but without a randomized control trial, there is no way the success can reliably be attributed to the medications That's non-sense, if everyone that had cancer got cured by a miracle drug, would you still demand a randomized control trial?
  - h_r 7y ago
    It's simply a problem of what is considered to be evidence in the scientific community. If everyone "got cured by a miracle drug", that implies you already have the compelling evidence in hand that the drug, in fact, is a cure. This is an example of begging the question.
    - Dylan16807 7y ago
      It's not begging the question at all! The entire point is that you can have compelling evidence without a randomized controlled trial.
      - h_r 7y ago
        Again, this is the very thing that needs to be shown. You're simply repeating the same mistake. The post I was responding to really had no _point_, per se. It merely asserted that it's ridiculous to require such experiments because... miracle drug!
        Dylan16807 7y ago
        > Again, this is the very thing that needs to be shown. You're simply repeating the same mistake. "This" being the idea that "compelling evidence" and "evidence from randomized controlled trials" are not the same thing? That has been shown. The cliche example is parachutes. We have compelling evidence that they save lives, even though nobody has ever done a proper trial. Experiments don't have to be perfect to provide valid data. And there are things you can learn from observation even without an explicit experiment. Nobody is suggesting that we would take an unknown drug and call it a miracle drug without evidence. When someone has a miracle drug in a hypothetical, pretend they're holding a bottle of penicillin and they've gone to a country where nobody has ever heard of penicillin. How should that country react when it immediately cures almost everyone with a certain disease? Do they really need a randomized trial to be confident it works?
gonational 7y ago
Has anyone noticed that the CDC’s reported deaths by week from ordinary flu and pneumonia have been plummeting while COVID-19 death rise? They are down from the normal 4.5k+ per week during this period to around 2.3k per week and they are falling parabolically as COVID-19 expands. What could cause this?
- hprotagonist 7y ago
  your tone is very conspiracist, which i suggest you reevaluate. an innocent answer, of course, is that physical distancing works.
- mjul 7y ago
  The Danish Serum Institute runs a “sentinel” testing programme for the common flu, and they note in their report about covid-19 last week (available in Danish) that the common flu has mostly been eliminated since the social distancing and lockdown measure were implemented. They interpret this a leading indicator for the reduction in covid-19 since it has a similar transmission mechanism.
  - foota 7y ago
    Would be amazing if we managed to eliminate the common flu as a side effect of this :) not likely, but it does seem possible?
    - obituary_latte 7y ago
      There’s an interesting docuseries on Netflix that is partially about a team that is working on a permanent 1-shot flu vaccine: https://www.netflix.com/title/81026143 https://www.netflix.com/title/81026143
- cjbprime 7y ago
  Social distancing, of course. How do you think people get the flu?
- jjeaff 7y ago
ck2 7y ago
It's more likely ivermectin, FDA/WHO approved, cheap, well tested on both animals and humans and aggressive against covid19 in virto https://www.sciencedirect.com/science/article/pii/S0166354220302011 https://www.sciencedirect.com/science/article/pii/S016635422... https://www.who.int/bulletin/volumes/82/8/editorial30804html/en/ https://www.who.int/bulletin/volumes/82/8/editorial30804html... every dog, cat and horse that is on heartworm medication is already using it
nradov 7y ago
Why is this flagged? It seems like an interesting article from a reputable source.
- deleted 7y ago
  [deleted]
- downerending 7y ago
  I'm guessing it's because the organization has been praised by a number of well-known people on the right (e.g., Steve Forbes, Ben Carson). And because the question of whether or not this drug works, or even should be used at all, seems to have become highly politicized. I think I read that at least one US governor threatened to pull the medical license of any doctor that used it. I don't have any idea whether this drug might be useful, but I think our most boring, apolitical scientists should be making that call. It could well end up that it sort of works, some of the time, perhaps in combination with other drugs or factors. Conceivably this will be solved the way AIDS ultimately was, slowly zeroing in on a set of treatments that mostly work.
  - nradov 7y ago
    US state governors don't have the authority to pull medical licenses.
    - downerending 7y ago
      Perhaps. I believe that doctors are licensed at the state level, and if I were a doctor, I wouldn't care to cross a governor making such a statement.
tgafpc2 7y ago
This site also has an article wistfully praising Remdesivir, a proprietary drug with far less evidence than HCQ. I think money might be talking here.
- cjhopman 7y ago
  A proprietary drug whose maker has said they will donate all 1.5 million doses that they currently have. That's more than they'll be able to produce over the next year (1 million) even after greatly increasing that production capacity.
  - pseudalopex 7y ago
    The goal is more than 1 million treatment courses (10 million doses) by the end of this year. https://www.gilead.com/stories/articles/an-update-on-covid-19-from-our-chairman-and-ceo https://www.gilead.com/stories/articles/an-update-on-covid-1...
    - cjhopman 7y ago
      Ah, I had misread that. That statement didn't clearly say whether they were going to donate those that they haven't produced yet. If they aren't donating that, this donation is like a ~10% discount (compared to the ~66% discount I had originally interpreted it in that case).
- af33 7y ago
  A lot of people just don't believe an old, boring drug cocktail can prove effective against a new disease.
ucha 7y ago
This morning we had: France ex-IHU Marseille/AP-HP: 79160 cases, 7527 dead, mortality rate 9.5% IHU Marseille/AP-HP: 3005 cases, 33 dead, mortality rate 1.1% France doesn't use HCQ consistently yet. Didier Raoult who heads the IHU in Marseille has been using it systematically on all cases, even mild ones for more than 2 weeks. I doubt such a difference in mortality rate could be explained by a difference in number of tests performed or other parameters. Everyone can have all sorts of opinions on the efficacy of the treatment but in the end, mortality rates don't lie. And no, differences in the level of care, health or other smaller factors cannot explain an 8x difference. In addition to that, most patients seem to have elevated ferritin which would be a side effect of consuming too much iron. In this case, it is theorized that when the virus replicates, it creates non-essential proteins that take place of the iron in hemoglobin thus preventing red blood cell from carrying O2 and CO2 from and back to the lungs. Based on molecular simulations, it seems that HCQ can bond to those viral proteins preventing them from expelling iron from hemoglobin. It would also explain why it's useful to treat someone early on rather than later when their hemoglobin lost their iron... Source here: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...
- inamberclad 7y ago
  It also doesn't count for confounding factors. Were all the patients of the same health? Did they all have the same supportive equipment? Did they all begin treatment at the same time after symptom onset? These are all questions that need to be addressed, the sooner the better.
  - ucha 7y ago
    It doesn't. We have to make a decision with uncertainty unfortunately. However, I don't think any of those questions could explain an 8x difference apart from the time of treatment. In Marseille, they treat you immediately independently of the severity of symptoms.
- wolco 7y ago
  Each of the 3005 had proper full care and were closely watched. We don't know about the 79160. The difference in mortality could be a number of factors.
swader999 7y ago
From what I've read it only works when given very early in the illness.
podgaj 7y ago
Can someone explain the dearth of research looking out how zinc deficiency might explain variations in outcome after SARS-CoV-2 infection? Both ADAM17, which helps ACE2 shed from the cell, and ACE2 itself, are zinc finger proteins and use zinc as a cofactor.
snapetom 7y ago
“ There is absolutely no evidence that HCQ or HCQ/azithromycin would have any effect on seriously ill patients with viral pneumonia.” Correct. that’s against the thought right now. HCQ is great at preventing patients from getting to the serious pneumonia stage. Once they’re on a vent, they should be on another cocktail.
- jojo2000 7y ago
  Yes, once they're on a vent, your main problem is not even the viral load, but rather that the body reacts to the infection in desperate ways like cytokine storm [0] which destroys organs. [0] https://en.wikipedia.org/wiki/Cytokine_release_syndrome https://en.wikipedia.org/wiki/Cytokine_release_syndrome
pbreit 7y ago
There's a bizarre resistance to these drugs with the only possible explanation being Trump Derangement Syndrome.
fareesh 7y ago
I have G6PD deficiency and there are mixed opinions on whether this form of chloroquine is safe for me to take. The deficiency affects about 400M people worldwide, surprised to see that this part of the discussion rarely gets brought up.
af33 7y ago
> There is absolutely no evidence that HCQ or HCQ/azithromycin would have any effect on seriously ill patients with viral pneumonia It's supposed to be taken BEFORE you become seriously ill and develop ARDS. In fact, many elites are put on a short course of HCQ/Z-Pak as soon as they show symptoms, even before the results of their tests come back (which can take days). > https://www.cbsnews.com/news/coronavirus-treatment-drug-hydroxychloroquine-doctor-prescription-family-friends/ https://www.cbsnews.com/news/coronavirus-treatment-drug-hydr...

I think this drug has become too politicized to be able to have a factual scientific debate.

deleted 7y ago
[deleted]
abnry 7y ago
Which is really, really a shame.
jkachmar 7y ago
You are commenting on an article that is nearly as apolitical as I can imagine one being to say that politicization of this topic makes it impossible to have a debate rooted in science. Isn’t this precisely an injection of politicization into a summary of scientific work?
shripadk 7y ago
Exactly! On one hand some scientists swear by these drugs and on the other hand other scientists are opposing it. It is science after all. It either works or it doesn't. There is no "probably isn't the answer" in this. It is almost like Big Pharma is fighting out their battles through these scientists.
- gpm 7y ago
  > It either works or it doesn't. No, not really. What the criteria for starting/stopping treatment are (e.g. is it being given to early or late stage patients), what other treatments/drugs are also used, what dosage is used, etc can all effect this.
brmgb 7y ago
It's really a shame the whole world stops at the border of the USA so there is no other place this debate could happen.
- justin66 7y ago
  I'm grimly curious, are the Rupert Murdoch media outlets overseas pushing these drugs as enthusiastically as they're doing here in the US?
- makomk 7y ago
  Unfortunately, while the whole world doesn't stop at the borders of the USA, neither does the political bullshit eminating from it. All the claims about what's effective or ineffective as a solution to Covid-19 that politicians and journalists latch onto for political reasons leech out into the rest of the world and cause trouble there too.
jacquesm 7y ago
"If there was any effect of this drug on COVID-19, it was minimal. Hydroxychloroquine, whose toxicity is far lower, may be safer than chloroquine. But that doesn't matter if the drugs are ineffective." What's political about that? The whole idea that if there were a simple and cheap cure that it would be politicized to the point where it won't see widespread application is ridiculous.
- shripadk 7y ago
  > What's political about that? Then why does the title say that Hydroxychloroquine "probably" isn't the answer? It either works or it doesn't. If the drugs are ineffective just say so. Why beat around the bush with a "probably"?
  - deleted 7y ago
    [deleted]
  - jacquesm 7y ago
    Probably as in 'not yet 100% sure'. As a measure of probability based on available evidence.
    - Natsu 7y ago
      To me, the headline reads like it's saying "this probably won't work" rather than "we don't yet have enough evidence to say that this works." If I had to headline this article, I probably would have written something like "Hydroxychloroquine data still inconclusive, don't get your hopes up yet" to better convey the meaning. From reading it, what the article actually supports is that we have seen two trials that are inconclusive. This is the meat of it in my view - == A French study of HCQ suggested that it had was effective in decreasing the viral load from nasal secretions. When azithromycin was added the magnitude of the effect was larger. [...] And a Chinese study of 30 patients doesn't prove that HCQ worked. Or that it doesn't. But the two groups, control and treated, showed no difference in the amount of virus in the throat on day seven, the length of time for the fever to go away. There was an apparent difference in the progression of the infection (determined by x-ray), in the two groups but this means little since 5/15 treated patients got worse vs. 7/15 in the control group. This effect could easily be by chance and nothing to do to the drug. Furthermore, this trial did not include azithromycin, so it cannot be compared to the French trial.
justin66 7y ago
Someone went really nuts with flagging and downvoting these comments.
- mrfusion 7y ago
  Yeah this was up to +6 for a while. Pretty bizarre.

If it would have situation altering effects we would already know. Huge effects would have been seen very early in the wide spread application of it.

Ozzie_osman 7y ago
I'm not so sure. Let's say it halves the number of deaths or halves the time it takes for someone to get better. But also it requires a certain dose to be most effective. How would you know in this fog of war? You'd still have many patients who are sick or dying. The whole point of this article is that it's really hard to know without controlled, randomized trials. And I agree.
- ysleepy 7y ago
  Sure, but more so than all the other drugs? People just have a problem with a no-information-yet state, they'd rather talk about the unfounded rumor than acknowledge that people are hard at work and there is no definitive news yet.
pbreit 7y ago
Not necessarily. There are still a few variables like when it is offered, what drug combinations, comorbidities, dosage, etc.

williesleg 7y ago

Of course it is. People just have Trump Derangement Syndrome and it's clouding their judgment. Get over it. Or not. Hey, in fact, if not, just don't take it. One less libtard voter.

logicbombr 7y ago

Prevent Senior in Brazil, an health operator with mosts of its patients on risk groups (60+ yo) are using hydroxychloroquine on all its COVID-19 patients with tremendous success. Right now I choose to believe on MD in front line rather then in Health Societies, FDA, WHO and those bureaucrats who let the virus spread all around due to its incompetence

hprotagonist 7y ago
as we say on the internet, [citation needed]
jacquesm 7y ago
Do you have a reference for this?
- Neekerer 7y ago
  He heard it from someone on the internet
- andrenth 7y ago
  This local news article (in Portuguese) has quotes from Prevent Senior executives: https://www.diariodaregiao.com.br/_conteudo/2020/04/cidades/saude/1190185-medicos-relatam-sucesso-no-uso-da-hidroxicloroquina-em-pacientes-com-covid-19.html https://www.diariodaregiao.com.br/_conteudo/2020/04/cidades/... “Every patient showing symptoms and with CTs indicating the presence of Covid-19 are invited to join the protocol. We’ve discharged more than 200 patients”.
- logicbombr 7y ago
  You can use Google Translate https://www.google.com.br/amp/s/noticias.uol.com.br/saude/ultimas-noticias/redacao/2020/03/23/prevent-senior-usa-cloroquina-em-todos-os-pacientes-com-coronavirus.amp.htm https://www.google.com.br/amp/s/noticias.uol.com.br/saude/ul... Hospitals like Albert Einstein and Sirio Libanês are also using it but patients must sign a term and take full responsibility over any complications.
greatjack613 7y ago

PragmaticPulp 7y ago

Collectively, we need to get over the idea of all-or-nothing solutions to Coronavirus. We're not going to wake up one day with a "cure" for COVID-19. No one in the medical field actually expects Hydroxychloroquine to produce miraculous recoveries at this point. The idea is that any treatment that slows the progress of the infection will also buy the patient's immune system more time to fight the infection. If we can push the peak symptoms back even 1-2 days relative to untreated individuals, that gives the immune system that much extra time to mount an effective defense against the virus. When we finally confirm which treatments, if any, are useful for slowing the progress of the infections, we can combine them with earlier testing and identification to help reduce the number of patients who require hospitalization. It won't look like a cure, but it will be making improvements in treatment outcomes and reducing the burden on hospitals. At this scale, a small modification of disease severity can still be useful for minimizing the burden on hospitals, even if it doesn't fit the narrative of a miracle cure.

gus_massa 7y ago
> The idea is that any treatment that slows the progress of the infection will also buy the patient's immune system more time to fight the infection. Is there any serious trial that shows that Hydroxychloroquine has any effect at all?
- Mountain_Skies 7y ago
  Double blind peer reviewed trials are a good goal but in the middle of a crisis you can't let a desire for perfection get in the way of the good. There is enough imperfect evidence that this treatment stack (that is, several drugs used in combination with hydroxychloroquine) has benefits that it should be considered a potential part of a solution. Waiting a couple of years for perfect studies to be carefully conducted is waiting until the crisis is over and the treatment moot. What is well known are the side effects of this drug, their likelyhood, and how to ameliorate them.
  - gus_massa 7y ago
    > There is enough imperfect evidence that this treatment stack [...] has benefits that it should be considered a potential part of a solution. Is there any evidence? Do you have a link to the best evidence so far? Did someone tried a similar treatment and get the same result? It is not necessary to have a perfect study, because there too little time. But how hard is to make a study with a randomized control group? You are not sure if this drug is better or worse, so giving only the standard treatment perhaps is better. I guess a double blind experiment is more difficult for logistic reasons, but if the patients have respirators and are sedated, it is almost a single blind experiment. And if the results are the number of death or an analysis in a lab by a machine (instead of self reports), they can be less influenceable.

stri8ed 7y ago

Not to diminish the possible successes, but without a randomized control trial, there is no way the success can reliably be attributed to the medications. That's not to say they should stop prescribing it, simply due to lack of formal trials. But the perceived benefits should not be taken at face value, yet.

hexl 7y ago
> but without a randomized control trial, there is no way the success can reliably be attributed to the medications That's non-sense, if everyone that had cancer got cured by a miracle drug, would you still demand a randomized control trial?
- h_r 7y ago
  It's simply a problem of what is considered to be evidence in the scientific community. If everyone "got cured by a miracle drug", that implies you already have the compelling evidence in hand that the drug, in fact, is a cure. This is an example of begging the question.
  - Dylan16807 7y ago
    It's not begging the question at all! The entire point is that you can have compelling evidence without a randomized controlled trial.
    - h_r 7y ago
      Again, this is the very thing that needs to be shown. You're simply repeating the same mistake. The post I was responding to really had no _point_, per se. It merely asserted that it's ridiculous to require such experiments because... miracle drug!
      - Dylan16807 7y ago
        > Again, this is the very thing that needs to be shown. You're simply repeating the same mistake. "This" being the idea that "compelling evidence" and "evidence from randomized controlled trials" are not the same thing? That has been shown. The cliche example is parachutes. We have compelling evidence that they save lives, even though nobody has ever done a proper trial. Experiments don't have to be perfect to provide valid data. And there are things you can learn from observation even without an explicit experiment. Nobody is suggesting that we would take an unknown drug and call it a miracle drug without evidence. When someone has a miracle drug in a hypothetical, pretend they're holding a bottle of penicillin and they've gone to a country where nobody has ever heard of penicillin. How should that country react when it immediately cures almost everyone with a certain disease? Do they really need a randomized trial to be confident it works?

gonational 7y ago

Has anyone noticed that the CDC’s reported deaths by week from ordinary flu and pneumonia have been plummeting while COVID-19 death rise? They are down from the normal 4.5k+ per week during this period to around 2.3k per week and they are falling parabolically as COVID-19 expands. What could cause this?

hprotagonist 7y ago
your tone is very conspiracist, which i suggest you reevaluate. an innocent answer, of course, is that physical distancing works.
mjul 7y ago
The Danish Serum Institute runs a “sentinel” testing programme for the common flu, and they note in their report about covid-19 last week (available in Danish) that the common flu has mostly been eliminated since the social distancing and lockdown measure were implemented. They interpret this a leading indicator for the reduction in covid-19 since it has a similar transmission mechanism.
- foota 7y ago
  Would be amazing if we managed to eliminate the common flu as a side effect of this :) not likely, but it does seem possible?
  - obituary_latte 7y ago
    There’s an interesting docuseries on Netflix that is partially about a team that is working on a permanent 1-shot flu vaccine: https://www.netflix.com/title/81026143 https://www.netflix.com/title/81026143
cjbprime 7y ago
Social distancing, of course. How do you think people get the flu?
jjeaff 7y ago

ck2 7y ago

It's more likely ivermectin, FDA/WHO approved, cheap, well tested on both animals and humans and aggressive against covid19 in virto https://www.sciencedirect.com/science/article/pii/S0166354220302011 https://www.sciencedirect.com/science/article/pii/S016635422... https://www.who.int/bulletin/volumes/82/8/editorial30804html/en/ https://www.who.int/bulletin/volumes/82/8/editorial30804html... every dog, cat and horse that is on heartworm medication is already using it

nradov 7y ago

Why is this flagged? It seems like an interesting article from a reputable source.

deleted 7y ago
[deleted]
downerending 7y ago
I'm guessing it's because the organization has been praised by a number of well-known people on the right (e.g., Steve Forbes, Ben Carson). And because the question of whether or not this drug works, or even should be used at all, seems to have become highly politicized. I think I read that at least one US governor threatened to pull the medical license of any doctor that used it. I don't have any idea whether this drug might be useful, but I think our most boring, apolitical scientists should be making that call. It could well end up that it sort of works, some of the time, perhaps in combination with other drugs or factors. Conceivably this will be solved the way AIDS ultimately was, slowly zeroing in on a set of treatments that mostly work.
- nradov 7y ago
  US state governors don't have the authority to pull medical licenses.
  - downerending 7y ago
    Perhaps. I believe that doctors are licensed at the state level, and if I were a doctor, I wouldn't care to cross a governor making such a statement.

tgafpc2 7y ago

This site also has an article wistfully praising Remdesivir, a proprietary drug with far less evidence than HCQ. I think money might be talking here.

cjhopman 7y ago
A proprietary drug whose maker has said they will donate all 1.5 million doses that they currently have. That's more than they'll be able to produce over the next year (1 million) even after greatly increasing that production capacity.
- pseudalopex 7y ago
  The goal is more than 1 million treatment courses (10 million doses) by the end of this year. https://www.gilead.com/stories/articles/an-update-on-covid-19-from-our-chairman-and-ceo https://www.gilead.com/stories/articles/an-update-on-covid-1...
  - cjhopman 7y ago
    Ah, I had misread that. That statement didn't clearly say whether they were going to donate those that they haven't produced yet. If they aren't donating that, this donation is like a ~10% discount (compared to the ~66% discount I had originally interpreted it in that case).
af33 7y ago
A lot of people just don't believe an old, boring drug cocktail can prove effective against a new disease.

ucha 7y ago

This morning we had: France ex-IHU Marseille/AP-HP: 79160 cases, 7527 dead, mortality rate 9.5% IHU Marseille/AP-HP: 3005 cases, 33 dead, mortality rate 1.1% France doesn't use HCQ consistently yet. Didier Raoult who heads the IHU in Marseille has been using it systematically on all cases, even mild ones for more than 2 weeks. I doubt such a difference in mortality rate could be explained by a difference in number of tests performed or other parameters. Everyone can have all sorts of opinions on the efficacy of the treatment but in the end, mortality rates don't lie. And no, differences in the level of care, health or other smaller factors cannot explain an 8x difference. In addition to that, most patients seem to have elevated ferritin which would be a side effect of consuming too much iron. In this case, it is theorized that when the virus replicates, it creates non-essential proteins that take place of the iron in hemoglobin thus preventing red blood cell from carrying O2 and CO2 from and back to the lungs. Based on molecular simulations, it seems that HCQ can bond to those viral proteins preventing them from expelling iron from hemoglobin. It would also explain why it's useful to treat someone early on rather than later when their hemoglobin lost their iron... Source here: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surf...

inamberclad 7y ago
It also doesn't count for confounding factors. Were all the patients of the same health? Did they all have the same supportive equipment? Did they all begin treatment at the same time after symptom onset? These are all questions that need to be addressed, the sooner the better.
- ucha 7y ago
  It doesn't. We have to make a decision with uncertainty unfortunately. However, I don't think any of those questions could explain an 8x difference apart from the time of treatment. In Marseille, they treat you immediately independently of the severity of symptoms.
wolco 7y ago
Each of the 3005 had proper full care and were closely watched. We don't know about the 79160. The difference in mortality could be a number of factors.

swader999 7y ago

From what I've read it only works when given very early in the illness.

podgaj 7y ago

Can someone explain the dearth of research looking out how zinc deficiency might explain variations in outcome after SARS-CoV-2 infection? Both ADAM17, which helps ACE2 shed from the cell, and ACE2 itself, are zinc finger proteins and use zinc as a cofactor.

snapetom 7y ago

“ There is absolutely no evidence that HCQ or HCQ/azithromycin would have any effect on seriously ill patients with viral pneumonia.” Correct. that’s against the thought right now. HCQ is great at preventing patients from getting to the serious pneumonia stage. Once they’re on a vent, they should be on another cocktail.

jojo2000 7y ago
Yes, once they're on a vent, your main problem is not even the viral load, but rather that the body reacts to the infection in desperate ways like cytokine storm [0] which destroys organs. [0] https://en.wikipedia.org/wiki/Cytokine_release_syndrome https://en.wikipedia.org/wiki/Cytokine_release_syndrome

pbreit 7y ago

There's a bizarre resistance to these drugs with the only possible explanation being Trump Derangement Syndrome.

fareesh 7y ago

I have G6PD deficiency and there are mixed opinions on whether this form of chloroquine is safe for me to take. The deficiency affects about 400M people worldwide, surprised to see that this part of the discussion rarely gets brought up.

af33 7y ago

> There is absolutely no evidence that HCQ or HCQ/azithromycin would have any effect on seriously ill patients with viral pneumonia It's supposed to be taken BEFORE you become seriously ill and develop ARDS. In fact, many elites are put on a short course of HCQ/Z-Pak as soon as they show symptoms, even before the results of their tests come back (which can take days). > https://www.cbsnews.com/news/coronavirus-treatment-drug-hydroxychloroquine-doctor-prescription-family-friends/ https://www.cbsnews.com/news/coronavirus-treatment-drug-hydr...