8 ms·
Hydroxychloroquine Update for April 6
- kevingadd 7y agoThe possible high-mortality interaction with metformin is a terrifying prospect. Diabetes is so common... hopefully it's something that doesn't apply to humans.
- buboard 7y agoIn mice. Hcq has been around for a long time, you d think that if it was so lethal in humans someone would have noticed
- m0zg 7y agoCounterpoint: http://www.leparisien.fr/societe/sante/chloroquine-ne-perdons-plus-de-temps-l-appel-de-personnalites-medicales-03-04-2020-8293677.php http://www.leparisien.fr/societe/sante/chloroquine-ne-perdon... You can do double blind studies until your patients are literally blue in the face, or you can try what works now. That is literally the choice at the moment. According to Peter Navarro, a good percentage of NYC patients are getting HCQ at the onset of symptoms now. Cuomo wants more of it, because it "appears to be working". Oklahoma is giving it to patients, too (https://www.news9.com/story/41972631/state-secures-possible-coronavirus-cure-for-hospitals#.XotJyWjOGbE.twitter https://www.news9.com/story/41972631/state-secures-possible-...), as does LA (https://twitter.com/ABC7/status/1246998628331163649 https://twitter.com/ABC7/status/1246998628331163649). Italy saw its numbers of deaths stabilize once they started giving it. Marseille (where Raoult's hospital is) has the lowest fatality rate in all of France. If it works, we should see the recoveries shoot up in 5-7 days. HCQ is also available _over the counter_ in some countries, and is given out like candy all over Africa where there's risk of malaria.
- kevingadd 7y agoThe fact that you can buy the drug over the counter doesn't mean it's universally safe. The people being hospitalized here are already doing poorly so exposing them to additional risk is not something you should just do on a whim. As the linked post mentions, there are clear signs of potential risks associated with the use of HCQ. I hope for the patients being dosed with it now that it both works and is safe, but it's incredibly reckless to go 'it's over the counter so it's fine'. A healthy person taking a reasonable dose as a malaria countermeasure is not the same as a person on a ventilator in the ICU. Their immune system is in a different condition, so is their heart.
- m0zg 7y ago> doesn't mean it's universally safe _Table salt_ is not safe. Eat 100 grams of it and you will die. This does, however, mean that it's not as "dangerous" as the mainstream press wants you to believe. It's a 50 year old drug used all over the world. If it was "deadly", we'd know it by now. CDC itself recommends taking it _as a prophylaxis_ when heading to the areas where malaria might be present: https://www.cdc.gov/malaria/travelers/drugs.html https://www.cdc.gov/malaria/travelers/drugs.html
- tptacek 7y agoI think we can all intuitively see the distinction in risk tolerance between table salt consumption and HCQ consumption.
- m0zg 7y agoNow try to estimate the risk of _not_ consuming HCQ when you have C19 symptoms. Armchair virology and statistical studies are fun right up until the moment you get dry cough and shortness of breath.
- tptacek 7y agoYou mean, like, that I'll have an infarction because of Q-T disruption, probably won't do anything to ward off C19, and, if I'm dosing it "over the counter" "like candy", might not have even had C19 in the first place? Seems like I can distinguish the risks between that and table salt too.
- xienze 7y ago> I think we can all intuitively see the distinction in risk tolerance between table salt consumption and HCQ consumption. Good thing we have doctors that can decide the best course of treatment via HCQ then.
- tptacek 7y ago
- tptacek 7y agoSubstantial numbers of C19 patients are being given HCQ in C19 trials, but more than that, substantial numbers of newly-diagnosed C19 patients are already taking HCQ, since it's part of the standard of care for widespread conditions like rheumatoid arthritis. And those patients will of course have had the HCQ intervention before acquiring C19, not late in the course of their illness. It doesn't look like anyone is reporting unusual clinical success for those patients, while you can find clinical reports of QT disturbances (so: people are paying attention to this stuff).
- strken 7y agoDosages for arthritis are pretty low, though.
- ceejayoz 7y ago“You can do double blind studies until your patients are literally blue in the face, or you can try what works now.” https://en.wikipedia.org/wiki/Politician%27s_syllogism https://en.wikipedia.org/wiki/Politician%27s_syllogism
- deleted 7y ago[deleted]
- legostormtroopr 7y agoLinking to wikipedia articles about logical fallacies isn't a debate tactic.
- ceejayoz 7y agoThat's debatable. https://en.wikipedia.org/wiki/Rimshot https://en.wikipedia.org/wiki/Rimshot
- jonny_eh 7y ago> or you can try what works now If you don't do studies, how else do you know if it works? Or what dosage? Or when to administer? Or downsides?
- threeseed 7y ago> Peter Navarro An economist with zero medical background who from media reports is fighting against Fauci on this issue. Any hint of a cure will be taken by people as a reason to ignore social distancing and stay at home rules. Which will directly cause an uptick in cases and deaths. Hence we need to be very, very sure that any cure is a real one.
- bb88 7y agoAny drug with a high efficacy should be seen in small sample sizes. E.g. As a sample size of one, I know that consuming alcohol has a relaxing effect. And that's highly testable, one I wouldn't mind participating in. If n=11 and there was no deviation from the normal expectation, it's possible that there was some undetectable effect, but it's far more likely there was no effect.
- stri8ed 7y ago> Kentucky is giving it to patients, too. Source? > Italy saw its numbers of deaths stabilize once they started giving it. It appears the total number of cases also decreased. Which would suggest effect is likely due to social distancing. > Marseille (where Raoult's hospital is) has the lowest fatality rate in all of France Source?
- throwaway_pdp09 7y agoAgree with you. There should be some kind of sanction for dumb posts that make claims without references. Downvoting isn't enough.
- Klonoar 7y agoOpting to listen to Navarro over Fauci is a very odd choice. Look, I get that certain discussions on this damn site resist dragging politics into it all, but this is pretty important: Navarro has nowhere near the qualifications that Fauci does and there is no reason to listen to him on this. You're contributing to a larger problem with misinformation at a time when it's not needed. Listen to the medical professional, not the economist.
- tptacek 7y agoI think he's just relying on Navarro's reporting that HCQ is being used in NYC, which, it clearly is; it looks like it's being tried all over the place. You can probably safely quote administration officials on something that simple. If he quoted Navarro saying HCQ was working, that would be problematic, especially because it doesn't seem to be working.
- Klonoar 7y agoI don't interpret the comment that way, but more power to you if you do. Going on to note these places where it supposedly work(s|ed) is indirectly bolstering Navarro's status in a discussion where he shouldn't be involved, and more or less implying that it does work when it clearly isn't working as described.
- m0zg 7y agoYale School of Medicine is onboard with HCQ as well. I guess they're total schmucks over there, nowhere close to the genius of Derek Lowe, who's not even a doctor. /s Why can't you people admit that Trump was right? https://files-profile.medicine.yale.edu/documents/7801c631-3dcc-48fc-a438-3aa18f3b7130 https://files-profile.medicine.yale.edu/documents/7801c631-3...
- ck2 7y agoWhile other drugs are looking far more promising, there might be an obvious reason why despite lack of clear proof/results the president is pushing it so hard like everything else that motivates him: https://lawandcrime.com/covid-19-pandemic/major-producer-of-hydroxychloroquine-once-paid-michael-cohen-hefty-sum-for-access-to-trump/ https://lawandcrime.com/covid-19-pandemic/major-producer-of-...
- Mountain_Skies 7y agoIs it possible to corner the market on a generic drug that is produced across the world?
- kevingadd 7y agoGiven the widespread shortages of the drug, you could operate on a 'rising tide lifts all boats' model here and if you're one of only 3 large scale suppliers you know that you and your competitors will all be selling more product. I don't think it makes sense as a reasoning for boosting HCQ, though, and there are more obvious reasons why he'd promote it. If you want to make money this isn't how you do it.
- threeseed 7y agoWho says you need to corner the market ? It's much easier to ramp up production than start an entirely new process with a new drug. And given we are talking about timeframes of weeks and months and not years all of the existing manufacturers will have a significant lead.
- xienze 7y agoIt’s a decades-old generic drug that multiple companies produce. Literally anyone with the means to do so can make it. There’s not a lot of money to be made with a drug that costs $5 for a course of treatment. You might have a point if he was pimping some brand new drug that cost $5000 a month.
- dmh2000 7y agothat wouldn't explain why Gov Cuomo is also a fan
- raphlinus 7y agoI'm a fan of this review, and of Derek Lowe in general. I especially like the way he explains effect size and also the reasons why we have to be cautious when looking at promising drugs. Another take, by James Hamblin at the Atlantic: https://www.theatlantic.com/health/archive/2020/04/hydroxychloroquine-trump/609547/ https://www.theatlantic.com/health/archive/2020/04/hydroxych... This is written for a more general audience, and is not shy about taking on the more political aspects, including the clashing agendas of the people promoting HCQ and those urging a more skeptical approach.
- mirimir 7y agoYeah, I'm a huge fan too. And this is a great summary and perspective.
- war1025 7y agoMy completely anecdotal experience with the Hydroxychloroquine story is that researchers keep pooh-poohing it and people in the field keep having success with it. All I know is that based on the aggregate of information I've seen thus far, if I come down with Coronavirus, I want to be prescribed that stuff.
- tptacek 7y agoCan you cite American clinical testimonials for HCQ? HCQ trials appear not to be controversial: they're being tried widely. Who's saying it's working?
- benjohnson 7y agoQuinine used to come from the bark of a tree - that bark is available as a nutritional supplement. It's also is used to make the bitter taste of Tonic Water.
- buboard 7y agoSomeone did the calculations. Ppl need to drink 200 gin tonics per day
- microtherion 7y agoYes, but is there a downside as well?
- buboard 7y agoYeah alcoholism/liver/kidney failure obviously. It was meant as a joke
- hprotagonist 7y agoit mostly still does. You _can_ synthesize it but the yield's godawful.
- csours 7y ago
- pazimzadeh 7y agoTaking Chloroquine too soon might promote viral infection by inhibiting the anti-viral response. https://sciencedirect.com/science/article/abs/pii/S0166354216300237?via%3Dihub https://sciencedirect.com/science/article/abs/pii/S016635421... CQ is for patients who have uncontrolled inflammation in response to the virus, not to be taken as a prophylactic.
- dionian 7y agoChloroquine is more toxic than Hydrochloroquine, isn't it?
- kevingadd 7y agoIIRC the addition of the hydroxy to the drug means it's going to be more water-soluble so it would be easier to excrete in urine and flush it out of the system, which would count as "less toxic" if you squint when reading the paper I haven't seen any detailed discussions of the differences in toxicity, but one physician made a comment to that effect.
- tptacek 7y agoYou probably don't have to derive the relative toxicities axiomatically, since volumes appear to have been written about the lower toxicity of HCQ compared to CQ.
- HarryHirsch 7y agoThere is a clinical trial going on to check for just that. The hope is that when taken as a prophylactic it prevents entry into cells and give the immune system an advantage over the pathogen, but as you say, the immunosuppressive effects are a concern. We'll see soon enough.
- tptacek 7y agoRepeating myself, but: there's an extent to which that trial has already been running naturally, since lots and lots of people take doses of HCQ comparable to the C19 protocol already, for rheumatoid arthritis. Lots of those people are getting C19. Are you seeing reports that arthritic patients who get C19 are faring better?
- dmh2000 7y agoisn't it the azithromycin that causes the arrhythmia and i heard it is recommended to use doxycycline instead for anyone vulnerable to that side effect.
- kevingadd 7y agoErythromicin and azithromycin can have a negative effect but supposedly the chloroquine ALSO can have an effect, so subbing in doxycycline will help but might not be enough.
- sunnyP 7y agoI just read an article where Dr. Mohammud Alam in Long Island is treating covid19 patients that have heart issues with that combination. https://townhall.com/tipsheet/katiepavlich/2020/04/06/here-are-five-doctors-whose-patients-have-seen-recovery-with-hydroxy-chloroquine-n2566409 https://townhall.com/tipsheet/katiepavlich/2020/04/06/here-a...
- moron4hire 7y agoWhy are we talking about drugs in the public media? This is like people demanding certain drugs from their doctors because they saw it in pharmaceutical commercial.
- kevingadd 7y agoIn part there's a desire to tell people that we have "a cure" or "a vaccine" ready to go because it suppresses panic and anxiety by creating the impression that the problem is solved. Naturally, telling people that before it's actually true causes new problems, so now we have people fighting to combat misinformation.
- rsynnott 7y agoBecause various high profile idiots have been lying about them. In an ideal world maybe this would be staying out of the public eye, but it’s a bit late to put the genie back in the bottle now.
- threeseed 7y agoBecause it's actively being pushed by right-wing media and the President. We have a Presidential election in November. And there is a proven, strong correlation between the strength of the economy and your chance of being elected. You can't have a strong economy and people feeling happy when they are stuck at home without a job and fearful of leaving the house. So they need to get people back to work. And the only way that happens is if you can convince people that it's okay to get COVID-19 because there is some magical drug that will cure you if you end up in hospital.
- seppin 7y agoFacts. Sad, depressing facts.
- brandon272 7y agoThat might work if the election was say, within the next 15 to 30 days. Trying to scam the general population into believing that an unproven drug is some kind of "magic" cure is an awfully bold and risky move 7 months from an election, especially before a potentially staggering number of deaths has been realized.
- robocat 7y ago“hydroxychloroquine itself actually lowers the activity of the innate immune system; that’s why people take it for lupus and for rheumatoid arthritis. Many people are saying that perhaps it will work best if taken early in the course of infection” (from article.) Yet HCQ takes a very long time to act as an efficient immunosuppressant (1 to 3 months for Lupus) as per https://news.ycombinator.com/item?id=22798370 https://news.ycombinator.com/item?id=22798370 which seemed factual; but anyone have references to how long HCQ takes to become immunosuppressant? Hydroxychloroquine has a long half life in the body, so you have to wonder what effects there will be from using it, especially if it turns out to be ineffective. The original idea HCQ was useful was from long term users of HCQ, which may have quite different biological effects from short term usage in reaction to dosing. Also perhaps Lupus has a confounding factor that makes Lupus sufferers less susceptible to Covid19?
- treeman79 7y agoI have Sjogrens. A cousin to Lupus. One month after starting this drug I noticed a decrease in symptoms. I stopped taking it for a couple weeks. Symptoms started again. So works but is slow. The stimulant aspect however hits in an hour and last all day, and into the next morning. And oddly seems have some viagra like effects. I have to really be careful if I take other stimulants. Antibiotics also keep symptoms at bay, but doctors won’t write script despite success. This drug does a lot to the body. Good and bad.
- nwah1 7y agoVarious doctors have been using chloroquine with high dose zinc. One idea is that chloroquine is simply a zinc ionophore, and its other effects aren't so relevant. Zinc has a long history of being recognized as an important nutrient for the immune system. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109180 https://journals.plos.org/plosone/article?id=10.1371/journal...
- VEEG889 7y agoI was diagnosed with Rheumatoid Arthritis (RA). Early treatment with BEST HEALTH HERBAL CENTRE RA HERBAL REMEDY was effective. Now is doing an amazing job controlling the disease. No more joints pains, and Dr Joe said my condition will be fully reversed after complete treatment plans (7 weeks). For more information about this remedy visit this webpage: ww w. besthealthherbalcentre .c om
- m0zg 7y agoIn the left corner we have Derek Lowe, who's not a doctor. In the right corner we have the Yale School of Medicine which recommends HCQ for both the mild and severely ill patients: https://files-profile.medicine.yale.edu/documents/7801c631-3dcc-48fc-a438-3aa18f3b7130 https://files-profile.medicine.yale.edu/documents/7801c631-3... Let's see who will win.
- zimpenfish 7y agoThat Yale flowchat is basically "throw whatever we can at the patient and hope that something works". It's not a considered plan of treatment that has been thrashed out over years of trials and experiments.
- m0zg 7y agoAs opposed to Derek Lowe's "considered plan of treatment"?
- zimpenfish 7y agoAs opposed to his decades of work in pharmaceutical-related areas of organic biochemistry, yeah.
- m0zg 7y agoNone of which was in the proximity of an actual living, breathing patient.