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Eli Lilly says its monoclonal antibody cocktail is effective against Covid-19
- war1025 6y agoSounds like Trump got a similar cocktail from a different company. The speed of his recovery and the fact that him having Coronavirus isn't even part of the news cycle anymore seems like a strong indicator that the treatment is probably a game changer.
- satya71 6y agoOnly problem, I suspect, is it's super expensive and hard to produce in the large amounts required. So not as much of a game changer as we'd like. Still should save a few lives.
- war1025 6y agoTrump released a statement a few hours ago that they have hundreds of thousands of doses available and he's going to push to make it free to patients. Obviously, it's still unclear how the politics of all of it play out, but seems more promising than most things we've seen so far.
- ethbr0 6y ago> it's super expensive and hard to produce in the large amounts required It's hard, but less hard than some things. And we've been working on them for the last ~35 years. Here's a primer if you're curious: https://blogs.sciencemag.org/pipeline/archives/2020/04/27/monoclonal-antibodies-for-the-coronavirus https://blogs.sciencemag.org/pipeline/archives/2020/04/27/mo...
- gameswithgo 6y agoI am lucky enough to have solid insurance provided by work and I had to fight hard to get a monoclonal antibody covered. One that was actually approved by the FDA. The cost if you can't get insurance to cover it is ~$3,000 per dose.
- ethbr0 6y agoThe price, as with all things in American medicine, is what they think the market will bear. They're not trivial to make, but it's an understood process. That said, there's been a lot of research and money to get us to where we are today. So how to value that? I've no idea.
- MyelinatedT 6y agoTrump might still go south... It's hard to tell what's true on that front, and it's still early days. Still looks promising though.
- musicale 6y agoI assume that from Trump's perspective going south would not be a promising outcome.
- gameswithgo 6y agoA single person's progression with covid tells us absolutely nothing about the efficacy of the drugs he took.
- war1025 6y agoWell, it might not, but the article is about Eli Lilly saying their studies say the drug is effective, and the anecdotal evidence that Trump took it and recovered very quickly seems to add credence to that claim. People love to hate on anecdotes, but they have their place.
- crumpled 6y agoBut, he didn't take it. so there's not even an anecdote here.
- atlasunshrugged 6y agoDidn't he specifically take the version from Regeneron, not Eli Lilly?
- musicale 6y agoA single data point, even a somewhat uncertain one, is still a data point.
- sgift 6y agoOkay, here is the data point: If you get treated by some of the best doctors your country has to offer in an absolute state of the art facility in record time (i.e. almost no delay between outbreak of covid and detection) the given drug cocktail was effective (if we assume they don't lie about Trumps health. In the footage on his return to the white house he didn't look healthy at all). I'd argue that this certainly is a data point. Just not a very useful one.
- gameswithgo 6y agoThis is a tautology, and in no way addresses the point that absolutely nothing is learned about the efficacy of one of the drugs he took, by looking at a single data point.
- coding123 6y agoI don't understand how one person treated with something, just because they recovered, makes this a game changer. I also don't get why it would take "curing" the president to know of a specific cocktail that works. I kinda am losing all faith in all things medicine if we've had experience, as a whole, to try to treat 36 MILLION people with this issue and one specific treatment for one specific person, who happens to survive like 35 MILLION others so far. And THATS the winning combo, And it happens to be our president. It's like the other 35 MILLION was just junk data or something.
- war1025 6y agoThe relevance is that the President got wall to wall media coverage for being sick. And his is in a demographic (old, overweight, male) that puts him at an extremely elevated risk for serious illness. Doctors will do their job and scientists will do their job, and in the end decisions will be made based on the results of studies. That doesn't negate the enormous amount of positive press that this event will give to the treatment. Either way, it should be a signal that we are getting much better at treating the illness. Back in April, Boris Johnson, who is basically a Trump equivalent, but 20 years younger, spent a week in the hospital in very rough shape. The news on Cornavirus is in trending significantly in the positive direction, which is really all that matters.
- sk5t 6y ago> The news on Cornavirus is in trending significantly in the positive direction Positive in terms of increasing case numbers, yes.
- war1025 6y ago> Positive in terms of increasing case numbers, yes. As the number of people I know who have caught it grows, I have to say I don't really see that as a negative thing. Most of the new cases are in the young-adult demographic. Almost universally they suffer no long term complications and the most unpleasant part of the sickness is being confined to their home for a week and a half. Number of confirmed cases is the wrong metric. We know very well by now who is at elevated risk. If you are not in the elevated risk category, and you are able to avoid those who are at elevated risk, then there is very little for you to worry about.
- tathougies 6y agoTrump's illness is still the most likely outcome for anyone with covid. The biggest difference is that the man is tested everyday.
- analog31 6y agoPerhaps one useful outcome of that experiment is that testing alone doesn't prevent a workplace from becoming a super spreader site.
- lehi 6y agohttps://i.imgur.com/MhtMWzi.gif https://i.imgur.com/MhtMWzi.gif
- segmondy 6y agoYup, which lead to early treatment. Most people start treatment when the illness has progressed far. Hospitals generally withhold treatment to see if patients will recover by themselves because they can't risk "waste" of medicine and filling up hospital beds. So most people are sent home unless it's really bad. Trump started getting treatment from the very moment he tested positive.
- avs733 6y agorelying on a PR team for data (who has a perfectly reasonable national security reason for lying about that data) and then using a single point of data to make claims is just so antiscience I can't even.
- pengaru 6y agoIt could just as well be a strong indicator that his initial viral exposure was small, and/or that being detected early, treated quickly and exceptionally well by a dedicated team matters.
- madengr 6y agoDid he stop taking HCQ? I know me media demonized that despite a 60 year safety record.
- tankist 6y agoDetail info about his treatment been discussed by TViW https://pca.st/episode/015f8d9c-7c9b-443a-a7eb-3bdf06e9602d https://pca.st/episode/015f8d9c-7c9b-443a-a7eb-3bdf06e9602d
- bronco21016 6y agoWhy are we assuming he’s out of the woods and “cured”? All of the medical experts seem to indicate that 7-10 days is when the real complications begin. The earliest we know him to be infected is Wednesday of last week. He’s just coming up on the 7 day threshold. Let’s at least wait through the weekend before we declare him “cured”.
- dTal 6y agoExactly. I'm shocked at how many people are taking Trump's "recovery" at face value.
- rsynnott 6y agoI... think that would be an _extremely_ premature assumption.
- HarryHirsch 6y agoMeanwhile, convalescent plasma does nothing at all for Ebola patients, and efficacy against coronaplague is at best low.
- delhanty 6y agoIt's completely predictable that the expensive drugs that Trump got (the monoclonal antibodies & Remdesivir) dominate the news cycle, while the cheap ones don't. From, the Physician to the President's report on October 2nd [0]: >Following PCR-confirmation of the President’s diagnosis, as a precautionary measure he received a single 8 gram dose of Regeneron’s polyclonal antibody cocktail. He completed the infusion without incident. In addition to the polyclonal antibodies, the President has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin. If there's a game changing drug for COVID-19 in there I'd say it was vitamin D. We covered the Spanish randomized open label, double-masked clinical trial of vitamin D just over a month ago. [1][2] >“Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p < 0.001.” [0] https://twitter.com/PressSec/status/1312122950133272576 https://twitter.com/PressSec/status/1312122950133272576 [1] https://www.sciencedirect.com/science/article/pii/S0960076020302764 https://www.sciencedirect.com/science/article/pii/S096007602... [2] https://news.ycombinator.com/item?id=24366006 https://news.ycombinator.com/item?id=24366006
- deelowe 6y agoThat trial has several issues. Everyone is patiently awaiting larger RCTs to further understand if Vitamin D does anything as a prophylactic. It's been shown to not be helpful in severe cases.
- cameldrv 6y agoThe Spanish RCT was for hospitalized patients. What study shows that it's not helpful for severe cases?
- delhanty 6y ago>That trial has several issues. Which are what? >It's been shown to not be helpful in severe cases. That's a fairly strong assertion! Stronger than, "there is no evidence that is helpful in severe cases" for example. You wouldn't happen to have a reference to back it up by any chance? Anyway, I'm wondering why vitamin D is held to a higher standard than the polyclonal antibodies or Remdesivir. Where is the evidence that they're helpful in severe cases? By the way, I'm not advocating for long-term, high-dose consumption (say over 2000 IU) consumption of vitamin D. Deva Boone (devaboone) 's blog points out that this can lead to dangerously high calcium levels and has been covered on here several times recently [0][1]: >Eventually we worked out what happened with Shannon: In 2013 she was diagnosed with mild osteopenia, a thinning of the bones that can be a precursor to osteoporosis. Her Vitamin D was low at the time, so her physician started her on over-the-counter Vitamin D supplementation at 5000 international units (IUs) daily. Five years later, she was still on this dose, and her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) Vitamin D builds up over time, so the longer someone is on a high dose, the more likely she is to develop toxicity. Shannon’s calcium levels began rising in the fall of 2018, when her severe symptoms developed. What we should be doing now is mass-testing the at-risk population to identify those people with blood levels below 30 ng/ml and then do what is necessary to bring them up into the 30 to 40 ng/ml range. Ideally that could be done with sunlight, or food high in vitamin D - for example oily fish, liver, dried-shitake, ... But for the at risk demographic, in practice one would probably need moderately high-dose supplements, combined with monthly testing until they're above 30 ng/ml, followed by a switch to a lower-dose maintenance dose. [0] https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story?postId=5f39453f8d01fe00170023fe https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st... [1] https://news.ycombinator.com/item?id=24261948 https://news.ycombinator.com/item?id=24261948
- all_blue_chucks 6y agoThis is promising technology, but the words "just barely statistically significant" should probably be in the first paragraph of articles covering this - not halfway down the article.
- mlyle 6y ago"Just barely statistically significant" but the MLE is a 6x reduction in hospital visits. There's huge potential here, but our ability to know has been hampered by study size.
- jszymborski 6y agoyes, I think this is a prime example of the "early results are promising but more testing is needed" platitude
- sxg 6y agoThat's not quite the right takeaway. That 6x reduction is dependent on the p-value, which in turn is dependent on the sample size. The larger the sample, the smaller the p-value, and that 6x reduction will likely shrink as well. It's extremely rare for a treatment in medicine to have a 6x benefit.
- mlyle 6y ago> That 6x reduction is dependent on the p-value, which in turn is dependent on the sample size No, the 6x reduction MLE is -not- dependent on the p-value, and this shows a fundamental misunderstanding of the statistics. That said, the overall distribution of possibilities skews on the "lesser effect" side, so if you had to guess which way the estimate would move with another trial, you're more likely to get a smaller effect than a larger one.... 6x is still the most likely single value. > It's extremely rare for a treatment in medicine to have a 6x benefit. All kinds of drugs and treatments for acute disease have a > 6x benefit. We have plenty of conditions that have a horrible prognosis untreated and great outcomes treated. Have a bad bacterial infection? Odds are abx will clear that right up and you'd die otherwise. Active TB has a ~60% death rate within 5 years untreated, while with normal treatment regimens only has a relapse (not death) rate of a few percent in that 5 year period. Most vaccines have high efficacies. Standard treatments can prevent the vast majority of malaria deaths.
- collyw 6y agoAren't monocolonial antibodies usually pretty expensive?