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Dr. Fauci and Big Farma

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Please indulge my well-earned cynicism. Let’s recap what’s been going on.

Dr. Raolt says that HCL is showing remarkable results with his CoVid patients. Dr. Raolt expands this study beyond his own clinic and patients. Dr. Fauci says that this is “anecdotal.”

A doctor in New York says that HCL, when given early on, is showing remarkable results: 80 to 90% of his patients are surviving (or, was it even higher?). Dr. Fauci says that this is “anecdotal.”

Then a study comes out that says that Remdisivir, produced by Gilead, has done a full clinical trial and that their drug lessens the time of illness from 14 days to 11 days but it only mildly improves the death rate. Dr. Fauci says: “This is significant.”

So a common drug that keeps people from dying is no more than some “anecdotal” musing. But a drug that shows mimimal improvement on death rates and recoveries is “significant.” Why such a reaction?

Well, the ‘common drug’ is dirt cheap and no big pharmeceutical company is going to make money on it. And pharmeceutical companies give money to the NIH and the CDC. I’ll let you come to a conclusion.

However, let’s be aware that big Farma is making huge money in the area of anti-viral drugs used as part of the ‘cocktail’ given HIV positive patients. Dr. Fauci has been in charge of this area for 35 years. Factor that into the conclusion you draw.

The WHO, who so ably handled themselves in this current outbreak (sarcasm alert), is responsible for introducing these highly expensive ‘anti-virals’ into Africa. It seems that whereever they found the HIV virus, these antivirals were introduced. And how did they know people had HIV? Because they tested them for antibodies to the virus. But, wait a second, when you have antibodies, that means that you’ve been exposed to the virus and fought it off, right? Isn’t this why we’re now so interested in testing people for antibodies?

So, just what kind of “science” lies at the bottom of all of this? And does the huge amount of government (and private–think Bill Gates, e.g.) money available affect, in any way, the “science” being employed.

I’d ask you to also factor these considerations into any conclusion you might reach.

Comments
kf -
And just what is Dr Raoult’s recommendation on the cumulative impact of cases?
I don't know. But that's not relevant to whether the has the resources to do the proper trials.Bob O'H
May 1, 2020
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F/N: Let me expand the AAPS argument: In addition to:
Clinicians are natural Bayesians and such philosophical and qualitative statistical analysis is consistent with our medical training, bedside clinical skills including history taking, examination, differential diagnosis, probable primary diagnosis, laboratory evaluations including serologies, EKG, chest X-ray, CT scan of lungs, objective gold standard test interpretation and clinical decision making. In other words, waiting for fixed randomized controlled trials during a pandemic when time is of the essence, a Bayesian approach to the assessment of diagnostic and therapeutic probabilities is wise and efficient and will save time, money and lives if the physicians are given a chance to retain their autonomy and practice medicine to the best of their abilities.
We may see:
Likelihood ratios and Bayes’ factors cannot be computed yet since fixed randomized controlled trials (RCTs) are just starting around the world. A flat prior (0.5 probability where 0 is impossible and 1 is certain) could be used to represent one’s beliefs about whether hydroxychloroquine (HCQ) would result in clinical improvement and/or prevention of death from CoVID-19 based on knowledge up to December 2019 and January 2020. Based on the new observational studies and reports from several (more than 10) different medical sources in February, March and April 2020, the prior will be updated using Bayes theorem yielding a posterior probability density when sufficient data to calculate likelihood ratios emerge. At present, physicians have a significant amount of basic science and human observational data to incorporate into their baseline knowledge of hydroxychloroquine safety and efficacy plus the current info included in this table will facilitate the physician as beliefs are updated accordingly. Based on the current clinical information available, the success rates for a favorable outcome/clinical improvement are approximately 91.6% using hydroxychloroquine (HCQ) [with] or without azithromycin (AZ) and/or zinc and the death rate in this treated group is approximately 2.7%. In comparison, the probability of death is 0.5-0.85 or 50 to 85% when patients with CoVID-19 are on mechanical ventilation and the probability of death based on Johns Hopkins University data worldwide is 206,544/2,971,477 or 6.95% as of 4.26.20. At this time, the data from 9 observational reports and one controlled trial suggest that hydroxychloroquine is dramatically more effective at preventing death from CoVID-19 than mechanical ventilation. It is encouraging to note that ventilated patients treated with hydroxychloroquine have been able to undergo successful extubation and transfer out of the intensive care unit onto the floor. Moreover, CoVID-19 viral loads have been reduced to low or undetectable levels after 5-15 days of treatment with hydroxychloroquine.
This puts on the table a substantial issue to be addressed. Let us do so. KF PS: My comments on Bayes and likelihood are here, in my always linked note.kairosfocus
May 1, 2020
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BO'H: And just what is Dr Raoult's recommendation on the cumulative impact of cases? Why is this being treated dismissively in the face of the epistemology of fairly reliable patterns and the statistics of fluctuations? KFkairosfocus
May 1, 2020
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MS, politically conservative -- a slur at notoriously biased Wikipedia -- is your answer to summary and to tabulation of results and papers? Note, kindly, this summary argument at the foot of their provisional tabulation, which is essentially about Bayesian revision of probability estimates on further evidence:
Clinicians are natural Bayesians and such philosophical and qualitative statistical analysis is consistent with our medical training, bedside clinical skills including history taking, examination, differential diagnosis, probable primary diagnosis, laboratory evaluations including serologies, EKG, chest X-ray, CT scan of lungs, objective gold standard test interpretation and clinical decision making. In other words, waiting for fixed randomized controlled trials during a pandemic when time is of the essence, a Bayesian approach to the assessment of diagnostic and therapeutic probabilities is wise and efficient and will save time, money and lives if the physicians are given a chance to retain their autonomy and practice medicine to the best of their abilities.
I strongly disagree with Marxists overall, but I am willing to acknowledge when they have a point. I am not aware of issues over vaccines and autism, but I do know these are yet another dismal tradeoff of lives vs lives as some will inevitably be hurt by vaccinations but overall significantly fewer are hurt than by epidemics. However, when there are rare diseases, the balance may well shift the other way, which is why I refused to subject my children to certain optional vaccinations. Vaccination is a dismal tradeoff issue, which may well be poorly understood or not appreciated by people afraid of or facing being on the getting hurt side. Certainly, growing up, in my neighbourhood there was a boy who was a victim of vaccinations gone wrong. In class at school I knew a polio victim who walked with a brace. I have a relative who was deafened in utero because of her mother catching German Measles. There is a needed, balanced discussion on herd immunity. The ability to openly have such a discussion is part of the social capital that is being squandered. Similarly, the basic principle of professionalism is well worth defending and the Governor clearly overstepped reasonable bounds; likely due to the precise concerns the AAPS objected to. As for the sales label, "evidence based medicine," the issue is what is inside the tin. On that, I found the imposition of the gold standard fallacy, disregard for ethical issues that do limit the applicability of double-blind, placebo control testing [especially in the face of a fast-moving, deadly pandemic that can often kill in a couple of weeks], imposition of selectively hyperskeptical dismissiveness towards evidence that is below their bar in an imposed hierarchy . . . implying failure to understand adequacy of cumulative observations for example. As I already discussed here and here i/l/o remarks by the Guardian I responded to here. Which last also shows how allegedly gold standard tests can be deliberately set up to fail. And if you think that political dismissal is an adequate response, kindly explain to me this rather similar summary from Italy, courtesy GT:
Hydroxychloroquine is one of the treatments against Coronavirus being tested, and is approved by AIFA (Italian Medicines Agency). The pioneer in this field is the Director of Hematology-Oncology of Piacenza, Luigi Cavanna. It was the first in Italy to use it, an intuition that is proving significant. “Since February 25, I have treated 209 patients and in 90% of cases the response has been positive. Hospitalizations have collapsed: from 30% of hospitalized (serious or moderate cases) to less than 5% “. The change, according to Cavanna, came with the administration of hydroxychloroquine from the earliest stages of the disease, when patients were at home, and resulted in the hospitalization of very few cases in acute conditions. A treatment that, according to preliminary data collected and systematized by 5 different ASLs on 1,039 patients, is working throughout Italy.
Maybe, there is some actual data to be addressed on the merits? What do the Italians, Israelis, Indians, Turks, South Koreans, French and others know that we may need to heed the cumulative warrant for? KFkairosfocus
May 1, 2020
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PaV @ 5 - there is no way you can argue Raoult doesn't have adequate funding.Bob O'H
May 1, 2020
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KF: https://aapsonline.org/aaps-letter-asking-gov-ducey-to-rescind-executive-order-concerning-hydroxychloroquine-in-covid-19/ https://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons: The Association of American Physicians and Surgeons (AAPS) is a politically conservative non-profit association founded in 1943. It is opposed to the Affordable Care Act and other forms of universal health insurance. The association is generally recognized as politically conservative or ultra-conservative, and its publication advocates a range of scientifically discredited hypotheses, including the belief that HIV does not cause AIDS, that being gay reduces life expectancy, that there is a link between abortion and breast cancer, and that there is a causal relationship between vaccines and autism. AAPS is generally recognized as politically conservative or ultra-conservative,[6][8] and its positions are unorthodox and at wide variance with federal health policy.[9] The Washington Post summarized their beliefs as "doctors should be autonomous in treating their patients — with far fewer government rules, medical quality standards, insurance coverage limits and legal penalties when they make mistakes".[9] It opposed the Social Security Act of 1965 which established Medicare and Medicaid and encouraged member physicians to boycott Medicare and Medicaid.[10] The organization requires its members to sign a "declaration of independence" pledging that they will not work with Medicare, Medicaid, or even private insurance companies.[11] AAPS opposes mandated evidence-based medicine and practice guidelines, opposes abortion and over-the-counter access to emergency contraception and opposes electronic medical records.MatSpirit
April 30, 2020
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UCLA is one of seven sites participating in a clinical trial investigating whether hydroxychloroquine, a commonly used anti- malarial and autoimmune drug, can prevent infection with COVID-19, it was announced Thursday. The multi-site study led by the University of Washington in collaboration with six other university centers, is now enrolling 2,000 participants who are close contacts of persons who are confirmed or suspected to be infected with COVID-19. The aim is to determine whether hydroxychloroquine can prevent infection in people exposed to the virus. The $9.5 million trial looking at post-exposure preventive therapy for COVID-19 is part of an initiative launched by the Bill & Melinda Gates Foundation, Wellcome and Mastercard to speed development and access to therapies against the respiratory virus that has spread throughout the world. The COVID-19 Therapeutics Accelerator is funded by the three organizations and an array of government and private sector donors. The hydroxychloroquine trial is one of many approaches the group is funding.rhampton7
April 30, 2020
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Big Pharma includes Novartis, does it not? Apr 20, 2020 Novartis has reached an agreement with the US Food and Drug Administration (FDA) to proceed with a Phase III clinical trial with approximately 440 patients to evaluate the use of hydroxychloroquine for the treatment of hospitalized patients with COVID-19 disease. The clinical trial drug supply will be provided by Sandoz, the generics and biosimilars division of Novartis. The large trial sponsored by Novartis will be conducted at more than a dozen sites in the United States. Novartis plans to begin enrollment for this study within the next few weeks and is committed to reporting results as soon as possible. To help achieve broad access to hydroxychloroquine as quickly as possible in these extraordinary circumstances, Novartis will make any intellectual property within our control that relates to the use of hydroxychloroquine to treat or prevent COVID-19 available through non-exclusive voluntary licenses, appropriate waivers, or similar mechanisms. The clinical trial complements a commitment by Novartis, through Sandoz, to donate up to 130 million tablets of hydroxychloroquine to supply global clinical research efforts in the event the medicine is proven beneficial for treatment of COVID-19. Sandoz has already donated 30 million tablets to the US Department of Health and Human Services and is dispatching futher shipments to countries based on requests from governments around the world.rhampton7
April 30, 2020
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Perhaps an example of parallelism. Doctor Fauci, Big Farma.daveS
April 30, 2020
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Language clue, likelykairosfocus
April 30, 2020
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PaV, did you misspell “Pharma” in the title intentionally?Ed George
April 30, 2020
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FFT https://aapsonline.org/aaps-letter-asking-gov-ducey-to-rescind-executive-order-concerning-hydroxychloroquine-in-covid-19/kairosfocus
April 30, 2020
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My god, you are a full-on HIV/AIDs denialist? I did not know such people still existed. The "reply" to Duesberg is the last 30+ years of research on HIV, the success of antiretrovirals in treating the disease, and the have HIV infection is the only thing routinely associated with AIDS to this day. Oh, and it hardly matters, but the PCR tests and antigen/antibody tests are different things. So a PCR tests is not going to discover HIV-encoded proteins in a patient's blood. The idea covid-19 deaths are over-reported is basically impossible to maintain in the face of excess mortality data: https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-toll-total.htmlorthomyxo
April 30, 2020
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Sev, what is your answer to the report and described or implied officially sanctioned actions in 4 above. What do the Italians know and why does this apparently fail to be recognised this side of the North Atlantic? KFkairosfocus
April 30, 2020
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Dr. Fauci And Big Farma
I smell a conspiracy theory.
Please indulge my well-earned cynicism. Let’s recap what’s been going on.
Okay, let's do that.
Dr. Raolt says that HCL is showing remarkable results with his CoVid patients. Dr. Raolt expands this study beyond his own clinic and patients. Dr. Fauci says that this is “anecdotal.”
Dr Fauci was referring to the first, very small trial reported by Dr Raoult for which we only had his word at that point. That was anecdotal.
A doctor in New York says that HCL, when given early on, is showing remarkable results: 80 to 90% of his patients are surviving (or, was it even higher?). Dr. Fauci says that this is “anecdotal.”
Again, we only had - and still only have - Dr Zelenko's word for how effective his treatment is. If you think that is enough then I have a compound, the formula for which was given to me in a vision, which will not only cure COVID-19 but the 'flu and HIV as well. I have already tested it on over 500 patients with a success rate of over 90%. Would you like to try some?
Then a study comes out that says that Remdisivir, produced by Gilead, has done a full clinical trial and that their drug lessens the time of illness from 14 days to 11 days but it only mildly improves the death rate. Dr. Fauci says: “This is significant.”
Yes, the results of a "full clinical trial" are significant, more so than anecdotal reports.
So a common drug that keeps people from dying is no more than some “anecdotal” musing. But a drug that shows mimimal improvement on death rates and recoveries is “significant.” Why such a reaction?
Because one treatment went through a full clinical trial. The others didn't. What's so difficult about that?
Well, the ‘common drug’ is dirt cheap and no big pharmeceutical company is going to make money on it. And pharmeceutical companies give money to the NIH and the CDC. I’ll let you come to a conclusion.
Conspiracy theory. I thought so.
However, let’s be aware that big Farma is making huge money in the area of anti-viral drugs used as part of the ‘cocktail’ given HIV positive patients. Dr. Fauci has been in charge of this area for 35 years. Factor that into the conclusion you draw.
Has it occurred to you that whoever is first with a really effective antiviral for COVID-19 stands to make rather a lot of money? That would be a strong motive for pushing the Raoult/Zelenko treatment regimes, wouldn't it? That's assuming they work as claimed.
However, let’s be aware that big Farma is making huge money in the area of anti-viral drugs used as part of the ‘cocktail’ given HIV positive patients. Dr. Fauci has been in charge of this area for 35 years. Factor that into the conclusion you draw.
So Dr Fauci alone has been suppressing less expensive but equally effective treatments for HIV? Another conspiracy theory?
So, just what kind of “science” lies at the bottom of all of this? And does the huge amount of government (and private–think Bill Gates, e.g.) money available affect, in any way, the “science” being employed.
The science is in the clinical trials, which protect the vulnerable from being exploited by the well-meaning but misguided or outright charlatans and frauds.Seversky
April 30, 2020
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Orthomyxo:
No. Basically no one “fights off” HIV, but we can develop antibodies, which keep the virus in check (The most commonly used tests also test for antigens, that is HIV encoded proteins).
Unfortunately, those "antigens" can be byproducts of other viruses that test positive because of the PCR technique's limitations. No one, to my understanding, has ever written anything to dismiss Dr. Peter Duesberg's criticism of HIV orthodoxy. Are you aware of any substantive reply? To go along with the HIV orthodoxy, Farr's Law is somewhat suspended. That's not a good starting point. CoVid-19 is not being treated in the same way as HIV: that is, if you have a number of underlying health issues and you test positive for SARS-CoV-2, then you will have died of CoVid-19. Here's an intersting article.PaV
April 30, 2020
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Bob O'H: Basic science? So, if you do a thorough study with relatively poor results, then the government is ready to fund it and recommend it. But, if you don't do a thorough study--because you might not have the financial resources a major pharmeceutical company has, then your fabulous results amount to nothing. Is this the way science should work? Or, just big Farma? Follow the money!PaV
April 30, 2020
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BO'H: What "non-evidence" or "low quality evidence" accounts for the following from the Italians? Namely:
Hydroxychloroquine is one of the treatments against Coronavirus being tested, and is approved by AIFA (Italian Medicines Agency). The pioneer in this field is the Director of Hematology-Oncology of Piacenza, Luigi Cavanna. It was the first in Italy to use it, an intuition that is proving significant. “Since February 25, I have treated 209 patients and in 90% of cases the response has been positive. Hospitalizations have collapsed: from 30% of hospitalized (serious or moderate cases) to less than 5% “. The change, according to Cavanna, came with the administration of hydroxychloroquine from the earliest stages of the disease, when patients were at home, and resulted in the hospitalization of very few cases in acute conditions. A treatment that, according to preliminary data collected and systematized by 5 different ASLs on 1,039 patients, is working throughout Italy.
Or, is it that we are seeing the gold standard evidence dismissiveness fallacy I have repeatedly pointed out. KFkairosfocus
April 30, 2020
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s. But, wait a second, when you have antibodies, that means that you’ve been exposed to the virus and fought it off, right
No. Basically no one "fights off" HIV, but we can develop antibodies, which keep the virus in check (The most commonly used tests also test for antigens, that is HIV encoded proteins). You seem to want to hark back to some good old fashioned 1980s HIV denialism, which hardly seems a useful diversion.orthomyxo
April 30, 2020
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so it’s not possible to know if they are showing that HCQ works.
Most definitely it is possible. Since there is no competing treatment, using published statistics will do to see if it works. Thousands of doctors are seeing patients and providing no treatment ther than ameliorating the symptoms usually with Tylenol. Basically HCQ or HCQ and zinc cannot do any harm. I know you will point me to the FDA and I will point you to the CDC and WHO both of whom said there was little if any potential for harm with HCQ type drugs. Then I will point you to those who have used it on several hundred patients without seeing any negatives. You should read this recommendation from some Harvard researchers if you haven't already.
We support the well-intentioned RCTs already underway in many medical centers. But tens of thousands will die before we have their results. In the meantime, anecdotal success stories, physicians’ highly personal experiences, and informal information networks are serving as the basis for widespread adoption of treatment protocols.
https://bit.ly/3bRxuuo This morning I had a short conversation with a representative of one of the largest religious groups in the country and was referred to the CDC for guidance when I suggested they might help in saving lives. Essentially they did not want to get involved in any discussion that was contrary to official government policy. So I suspect that you and he would get along very well.jerry
April 30, 2020
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So a common drug that keeps people from dying is no more than some “anecdotal” musing. But a drug that shows mimimal improvement on death rates and recoveries is “significant.” Why such a reaction?
Quality of the study. Raoult's first study was too small to be anything more than suggestive, and his subsequent studies (and Zelenko's) haven't had control groups, so it's not possible to know if they are showing that HCQ works. This is just basic science.Bob O'H
April 30, 2020
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