3 ms·

(Disclaimer: I'm not a medical professional, and I don't lay any claim to being authoritative. This is mostly anecdotal.) I suspect the difference in HCQ and r

by nrr 6y ago

(Disclaimer: I'm not a medical professional, and I don't lay any claim to being authoritative. This is mostly anecdotal.) I suspect the difference in HCQ and remdesivir dosing studies mostly has to do with the classes of drugs those are. One's an antimalarial, and the other's an antiviral. There might be more of a priority to explore what existing antivirals could have an effect. There could also be a sheepishness in wanting to conduct those studies with HCQ given that we still largely don't understand how it works. That said, apropos HCQ being associated with less mortality in advanced cases: As an antimalarial, it has some interesting immunosuppressive properties. Notably, it's used as a treatment for lupus in order to temper or moderate the kind of immune responses seen in those patients. I imagine that there's possibly some sort of (fatal if left untended) immune response that manifests in advanced COVID-19 that HCQ happens to keep down. Writing as an asthmatic who's had his fair share of IV antibiotics to deal with some truly gnarly bouts of pneumonia, acute respiratory distress syndrome is no joke. Any little bit to keep folks off ventilators is truly helpful.

joshstrange 6y ago
> There could also be a sheepishness in wanting to conduct those studies with HCQ given that we still largely don't understand how it works. How it works in what way? We have been using it since 1955 and people take it regularly. The risks are largely known. Remdesivir, on the other hand, is just over a decade old and is a drug in search of a problem (it was not useful in treating Ebola and I can't find any reference to it being used for other treatments). Maybe I should say it's an R&D budget in search of recouping the cost. Look, I don't hate Gilead, in fact they make drugs to both treat and preventive HIV/AIDS. The latter being something I've taken before. But something about this all stinks.
- giardini 6y ago
  joshstrange says>"We have been using it since 1955 and people take it regularly. The risks are largely known."< This. Actually "we" (the Western World) have been using it [quinine and variants] since the 17th century! And it is a fascinating story of political and medical intrigue and skill. Without quinine derived from the bark of the Peruvian cinchona tree, the British, Dutch et al could not have built their empires in malaria-infested regions of the world: "The global history of quinine, the world’s first anti-malaria drug": https://medium.com/@tcassauwers/the-global-history-of-the-world-s-first-anti-malaria-drug-d1e11f0ba729 https://medium.com/@tcassauwers/the-global-history-of-the-wo... There's are many books that discuss this history, among them: "The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World" by Fiammetta Rocco https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicine-Changed-ebook/dp/B0084WVECE https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicin... "The Fever: How Malaria Has Ruled Humankind for 500,000 Years" by Sonia Shaw https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-ebook/dp/B003R0LBT4 https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-e... There was apparently as much anguish between rival groups (Roman Catholics vs. reformists) about cinchona bark (from which quinine was first extracted) in days gone by as there is today between Democrats and Republicans on the use of quinine's descendents, the sythetic drugs known as (hydroxy)chloroquines. It has been said that Oliver Cromwell's death of malaria in 1658 was a result of his refusal to take "Jesuit's bark" because of Protestant suspicion of anything associated with Roman Catholics. Similarly today, Democrats may choose to die refusing "the Trump cure" rather than accept the shame of admitting even the possibility that HCQ/CQ might actually work against Covid-19.
  - joshstrange 6y ago
    Wow, that is utterly fascinating, I might have to grab one of those books. It’s not entirely surprising but I had not idea of all the history there. We really are doomed to repeat it. > Similarly today, Democrats may choose to die refusing "the Trump cure" rather than accept the shame of admitting even the possibility that HCQ/CQ might actually work against Covid-19. One of my biggest fears. Trump just latched on to any good news to try and rescue “the economy” but it just so happens it might turn out to be right. The longer they wait the worse the blowback and higher the death count. Swallow your pride and get more studies done on this! <he screamed into the void>
    - giardini 6y ago
      Problems that divide people politically and religiously have dominate man's history, often subsuming all topics of discussion and slowing the development of science. Note the reference to "the arrogance of sects [and] the hatred of the parties" in the following paper, titled "Products of the Empire: Cinchona: a short history" (well worth reading) at: https://www.lib.cam.ac.uk/collections/departments/royal-commonwealth-society/projects-exhibitions/products-empire-cinchona https://www.lib.cam.ac.uk/collections/departments/royal-comm... " Despite “the promptness of its effect and its infallibility” which “made it suspect for such a long time”, according to Ignace Vincent Voullonne writing in the early 18th century, cinchona bark “finally triumphed over the multiple reproaches that were heaped upon it … by ignorance, prejudice, the arrogance of sects [and] the hatred of the parties.” The use of this “Popish powder” had elicited considerable religious prejudice because of its association with the Jesuits. As demand grew, however, lack of experience of the bark, uneven consignments, incorrect identification, and the frequent and deliberate pollution of the product by adding the bark of other trees, all ensured the argument over its value was kept alive well into the 19th century." Does anyone else see significant parallels to today's discussions of what should be done, what is best, who is in charge, who supplies what, etc. in regard to Covid-19 and it's potential cures and treatments? One might think we have made little progress as a society in the intervening centuries!

by nrr 6y ago

joshstrange 6y ago

> There could also be a sheepishness in wanting to conduct those studies with HCQ given that we still largely don't understand how it works. How it works in what way? We have been using it since 1955 and people take it regularly. The risks are largely known. Remdesivir, on the other hand, is just over a decade old and is a drug in search of a problem (it was not useful in treating Ebola and I can't find any reference to it being used for other treatments). Maybe I should say it's an R&D budget in search of recouping the cost. Look, I don't hate Gilead, in fact they make drugs to both treat and preventive HIV/AIDS. The latter being something I've taken before. But something about this all stinks.

giardini 6y ago
joshstrange says>"We have been using it since 1955 and people take it regularly. The risks are largely known."< This. Actually "we" (the Western World) have been using it [quinine and variants] since the 17th century! And it is a fascinating story of political and medical intrigue and skill. Without quinine derived from the bark of the Peruvian cinchona tree, the British, Dutch et al could not have built their empires in malaria-infested regions of the world: "The global history of quinine, the world’s first anti-malaria drug": https://medium.com/@tcassauwers/the-global-history-of-the-world-s-first-anti-malaria-drug-d1e11f0ba729 https://medium.com/@tcassauwers/the-global-history-of-the-wo... There's are many books that discuss this history, among them: "The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World" by Fiammetta Rocco https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicine-Changed-ebook/dp/B0084WVECE https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicin... "The Fever: How Malaria Has Ruled Humankind for 500,000 Years" by Sonia Shaw https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-ebook/dp/B003R0LBT4 https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-e... There was apparently as much anguish between rival groups (Roman Catholics vs. reformists) about cinchona bark (from which quinine was first extracted) in days gone by as there is today between Democrats and Republicans on the use of quinine's descendents, the sythetic drugs known as (hydroxy)chloroquines. It has been said that Oliver Cromwell's death of malaria in 1658 was a result of his refusal to take "Jesuit's bark" because of Protestant suspicion of anything associated with Roman Catholics. Similarly today, Democrats may choose to die refusing "the Trump cure" rather than accept the shame of admitting even the possibility that HCQ/CQ might actually work against Covid-19.
- joshstrange 6y ago
  Wow, that is utterly fascinating, I might have to grab one of those books. It’s not entirely surprising but I had not idea of all the history there. We really are doomed to repeat it. > Similarly today, Democrats may choose to die refusing "the Trump cure" rather than accept the shame of admitting even the possibility that HCQ/CQ might actually work against Covid-19. One of my biggest fears. Trump just latched on to any good news to try and rescue “the economy” but it just so happens it might turn out to be right. The longer they wait the worse the blowback and higher the death count. Swallow your pride and get more studies done on this! <he screamed into the void>
  - giardini 6y ago
    Problems that divide people politically and religiously have dominate man's history, often subsuming all topics of discussion and slowing the development of science. Note the reference to "the arrogance of sects [and] the hatred of the parties" in the following paper, titled "Products of the Empire: Cinchona: a short history" (well worth reading) at: https://www.lib.cam.ac.uk/collections/departments/royal-commonwealth-society/projects-exhibitions/products-empire-cinchona https://www.lib.cam.ac.uk/collections/departments/royal-comm... " Despite “the promptness of its effect and its infallibility” which “made it suspect for such a long time”, according to Ignace Vincent Voullonne writing in the early 18th century, cinchona bark “finally triumphed over the multiple reproaches that were heaped upon it … by ignorance, prejudice, the arrogance of sects [and] the hatred of the parties.” The use of this “Popish powder” had elicited considerable religious prejudice because of its association with the Jesuits. As demand grew, however, lack of experience of the bark, uneven consignments, incorrect identification, and the frequent and deliberate pollution of the product by adding the bark of other trees, all ensured the argument over its value was kept alive well into the 19th century." Does anyone else see significant parallels to today's discussions of what should be done, what is best, who is in charge, who supplies what, etc. in regard to Covid-19 and it's potential cures and treatments? One might think we have made little progress as a society in the intervening centuries!