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Prof Risch answers critics:

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It’s worth headlining from the CV19 thread:

Jerry, 579: >>Dr. Risch strikes back. https://washex.am/2DFxdij

Hydroxychloroquine works in high-risk patients, and saying otherwise is dangerous

As of Wednesday, some 165,000 people in the United States have died from COVID-19. I have made the case in the American Journal of Epidemiology and in Newsweek that people who have a medical need to be treated can be treated early and successfully with hydroxychloroquine, zinc, and antibiotics such as azithromycin or doxycycline. I have also argued that these drugs are safe and have made that case privately to the Food and Drug Administration.

The pushback has been furious. Dr. Anthony Fauci has implied that I am incompetent, notwithstanding my hundreds of highly regarded, methodologically relevant publications in peer-reviewed scientific literature. A group of my Yale colleagues has publicly intimated that I am a zealot who is perpetrating a dangerous hoax and conspiracy theory. I have been attacked in news articles by journalists who, ignorant of the full picture, have spun hit pieces from cherry-picked sources.

These personal attacks are a dangerous distraction from the real issue of hydroxychloroquine’s effectiveness . . . >>

I picked up, in 632: >> . . . personal attacks are a dangerous distraction from the real issue of hydroxychloroquine’s effectiveness, which is solidly grounded in both substantial evidence and appropriate medical decision-making logic. Much of the evidence is presented in my articles.

[He references: “I have made the case in the American Journal of Epidemiology and in Newsweek that people who have a medical need to be treated can be treated early and successfully with hydroxychloroquine, zinc, and antibiotics such as azithromycin or doxycycline. I have also argued that these drugs are safe and have made that case privately to the Food and Drug Administration.”]

To date, there are no studies whatsoever, published or in pre-print, that provide scientific evidence against the treatment approach for high-risk outpatients that I have described. None. Assertions to the contrary, whether by Fauci, the FDA, or anyone else, are without foundation. They constitute misleading and toxic disinformation.

What do you need to know to evaluate these smears against hydroxychloroquine? The first thing to understand is that COVID-19 has two main stages. [–> see charts here, recall, suppressed by Google, HT Yandex]

I insert, the chart:

At the first stage, it is a flu-like illness. That illness will not kill you. If you are a high-risk patient and begin treatment immediately, you will almost certainly be done with it in a few days. When not [adequately?] treated, high-risk patients may progress. The virus then causes severe pneumonia and attacks many organs, including the heart. In this second stage, hydroxychloroquine is not effective.

So, if you are told that hydroxychloroquine doesn’t work, ask this question: In which patients? Does it not work in those who have just started to have symptoms, or those sick enough to require hospitalization?

The second thing to know is that most low-risk patients survive without treatment. Low risk means you are under age 60 and have no chronic conditions such as diabetes, obesity, and hypertension, have no past treatment for cancer, are not immunocompromised, etc. High risk means you are over 60 or you have one or more of those chronic conditions. High-risk patients need immediate treatment when they first show symptoms. One should not wait for the COVID-19 test result, which can take days and can be wrong. Again, when Fauci and others say that randomized controlled trials show no benefit for hydroxychloroquine, you must ask: In which group of patients?

Every randomized controlled trial to date that has looked at early outpatient treatment has involved low-risk patients, patients who are not generally treated. In these studies, so few untreated control patients have required hospitalization that significant differences were not found. There has been only one exception: In a study done in Spain with low-risk patients, a small number of high-risk nursing home patients were included. For those patients, the medications cut the risk of a bad outcome in half.

I reiterate: If doctors, including any of my Yale colleagues, tell you that scientific data show that hydroxychloroquine does not work in outpatients, they are revealing that they can’t tell the difference between low-risk patients who are not generally treated and high-risk patients who need to be treated as quickly as possible. Doctors who do not understand this difference should not be treating COVID-19 patients.

What about medication safety? On July 1, the FDA posted a “black-letter warning” cautioning against using hydroxychloroquine “outside of the hospital setting,” meaning in outpatients. But on its website just below this warning, the FDA stated that the warning was based on data from hospitalized patients. To generalize and compare severely ill patients with COVID-induced pneumonia and possibly heart problems to outpatients is entirely improper.

In fact, the FDA has no information about adverse events in early outpatient use of hydroxychloroquine. The only available systematic information about adverse events among outpatients is discussed in my article in the American Journal of Epidemiology, where I show that hydroxychloroquine has been extremely safe in more than a million users.

It is a serious and unconscionable mistake that the FDA has used inpatient data to block emergency use petitions for outpatient use. Further, already back in March, the FDA approved the emergency use of hydroxychloroquine for hospitalized patients, for whom it is demonstrably less effective than for outpatients. If hydroxychloroquine satisfied the FDA criteria for emergency inpatient use in March, it should more than satisfy those criteria now for outpatient use, where the evidence is much stronger.>>

Some reconsideration may be in order. END

PS: As a part of that, I have consistently pointed to the tendency to insist on the “need” for placebo controlled studies (an issue Risch also spoke to in his Newsweek article). In the discussion, I took time to address a bit of algebra:

KF, 566: >> [Let me insert a diagram on sustainability oriented decision making, adapted from the Bariloche Foundation of Argentina:]

7: Where, BAU is in fact a natural baseline of reference. We seek a more satisfactory alternative, ALT. It must be credible enough incrementally to justify onward exploration and that first requires becoming a candidate for more costly investigation that shifts epistemic probabilities. Where, of arguments by/among clever people there is no end, so empirical demonstration at various levels is pivotal.

8: Here, epistemology of empirically based knowledge does not allow for gold standards that impose selective hyperskepticism against otherwise reasonable evidence. Evidence is evidence (and various uncertainties, risks and potential for errors cannot be wholly eliminated). So, we must recognise that BAU is a baseline/ benchmark/ control, and there is no strict necessity to construct an artificial, no effective treatment baseline; call it 0TB.

9: After all, the point is really to improve outcomes from BAU, and gap analysis ALT vs BAU has no inherent reference to 0TB. Algebraically, on credible or observed outcomes,

(ALT – 0TB) – (BAU – 0TB) = ALT – BAU

Where, with people as test subjects, if 0TB is based on deception and has potential for significant harm, it becomes ethically questionable. We know of extreme cases of concentration camp experimentation, the Tuskegee syphilis atrocity and more. However in more recent times, people have been subjected to fake surgeries under general anesthesia etc. The placebo effect has covered a multitude of sins.

10: In the face of pandemic, urgency is another issue. What yields results in a timeframe relevant to taming the surge of cases becomes a highly relevant criterion. As does the tradeoff of lives lost under various treatment, public health [e.g. quarantines vs general lockdown] and policy options. Where, relevantly, economic dislocation carries a toll in health and lives too. (It is suggested by some that deaths of despair and from postponed medical procedures may/do exceed those attributed to the epidemic.) This means BTW that the dismal science, Economics, has a seat at the decision makers’ table as of right.>>

PPS: Design inference explanatory filter, per aspect form:

PPPS: The HCQ mechanisms, summarised by Frontline Doctors:

53 Replies to “Prof Risch answers critics:

  1. 1
    kairosfocus says:

    Prof Risch answers critics: — headlined

  2. 2
    Bob O'H says:

    I love this. The strongest evidence he has is this:

    To date, there are no studies whatsoever, published or in pre-print, that provide scientific evidence against the treatment approach for high-risk outpatients that I have described. None.

    So he’s suggesting a treatment that he admits doesn’t have any evidence to say it’s effective.
    Then he writes

    In these studies, so few untreated control patients have required hospitalization that significant differences were not found. There has been only one exception: In a study done in Spain with low-risk patients, a small number of high-risk nursing home patients were included. For those patients, the medications cut the risk of a bad outcome in half.

    Which backs up any suggestion that he’s incompetent. If he were competent he would understand that the confidence interval is (0.21, 1.17), so it’s not unlikely that there is no effect (from Fig. 3 of the preprint). In fact, if he were competent he would be aware of issues of multiple testing in subgroup analysis, so there’s a good chance that a significant result will happen by chance.
    Further he writes

    In fact, the FDA has no information about adverse events in early outpatient use of hydroxychloroquine. The only available systematic information about adverse events among outpatients is discussed in my article in the American Journal of Epidemiology, where I show that hydroxychloroquine has been extremely safe in more than a million users.

    Which he can only support if he hasn’t read the preprint that he was just quoting. In it the proportion of Adverse Events in the control group was 5.9% and in the HCQ group was 51.6%. I’m sure the FDA is aware of this.

  3. 3
    ET says:

    Bob, anyone who thinks that nature can produce coded information processing systems is incompetent. And that speaks to all people who are against ID. Yourself included.

  4. 4
    kairosfocus says:

    BO’H, there you go again with the gold standard fallacy. I first refer you to the PS above, to note the basic point. Next, you have dismissed a whole class of evidence to twist what was noted into a no-evidence claim, racing on to insinuations of incompetence. I hope you understand that it gives us the prudential right to read you by way of the mirror-projection principle. Then, you twisted

    Every randomized controlled trial to date that has looked at early outpatient treatment has involved low-risk patients, patients who are not generally treated. In these studies, so few untreated control patients have required hospitalization that significant differences were not found. There has been only one exception: In a study done in Spain with low-risk patients, a small number of high-risk nursing home patients were included. For those patients, the medications cut the risk of a bad outcome in half.

    . . . into almost its opposite by way of a confidence interval (where chance factors would be most unlikely to be flat-distributed). Here is your problem, in the background are thousands of vulnerable “outpatients” successfully treated with HCQ cocktails, with a strong pattern of rapid clearing of viral infection. In the counter studies there is a consistent pattern of misdirection (too consistent to be chance, it is a bias), and where a tiny window was opened up, boom, the outcomes for those patients showed a considerable difference. Maybe I need to resort to an old intel agent saying: once is chance, twice coincidence, thrice is enemy action. Strike one: sweeping away valid evidence, strike two: setting up counter studies built to fail, strike three: trying to dismiss the case where there was a tiny window which showed a result consistent with the actual pattern with the proper patients per the nature of viral, respiratory tract diseases. KF

  5. 5
    jerry says:

    So he’s suggesting a treatment that he admits doesn’t have any evidence to say it’s effective.

    That is now what he said. It is what you say to distort what he said.

    He said there is no evidence against it working. He also said there is plenty of evidence that it works. They are two very different statement and in no way could any rational person make the claim you did from this.

    If you want to make the claim that HCQ is harmful, then we can discuss that. But that is a very different proposition.

    I believe Todaro claimed about 12 deaths in the last 57 years from HCQ. They are his exact numbers but we can check other places

    Systematic review of cardiac complications attributed to routine hydroxychloroquine use…

    From the years 1963-2017:

    – Only 50 events of cardiac toxicity (since 1963!)
    – Total of 12 deaths
    – Median patient had been taking HCQ daily for 8 YEARS

    I have several references that point to HCQ’s harmlessness. But with any drug there will always be something.

  6. 6
    jerry says:

    I will repeat my comment made on the other thread

    —————–
    Kf above referenced the letter to Fauci from 3 doctors in California and Florida. Here is a link to it https://bit.ly/2FqvcXF

    It is long so may be in the category for many of TLDR. But it lays out in exquisite logical progression the case for HCQ and the case against opposition to it. Essentially, there is plenty of information that HCQ works. Almost none that it does not work. Also that it is extremely safe. It is also very inexpensive.

    So to ague against it is to argue for continued high death rates when there seems a good way to lower them dramatically. Why would anyone do that? But yet we have here on this site and in the society around us those that are doing so.

    Even if the drug combination did not work, why argue against it. It is safe and inexpensive. How many would not spent $10 to save their life or the life of a loved one? But that is what those who oppose HCQ are doing. Save the $10, and see if they die.

    Reminds me of the quote from a Man for All Seasons

    “For Wales? Why Richard, it profit a man nothing to give his soul for the whole world. . . but for Wales!”

  7. 7
    Mac McTavish says:

    KF

    BO’H, there you go again with the gold standard fallacy.

    Just labeling something a fallacy doesn’t make it one. Randomized controlled clinical trials are considered the “gold standard” because they are by far the best and most definitive means by which the efficacy and safety of a treatment can be determined. There is nothing fallacious about them.

    As previously mentioned, you appear to by hung up on the fact that the placebos are intentionally mislabeled. It is not important how the pills are labeled as long as both the placebos and active ingredient pills are identically labeled. Would you be happier if all pills were labeled as sugar, or not labeled at all?

  8. 8
    jerry says:

    Randomized controlled clinical trials are considered the “gold standard” because they are by far the best and most definitive means by which the efficacy and safety of a treatment can be determined.

    A couple non sequiturs in this statement.

    One is that several medical treatments have been established without an RCT and in a case where several of the control group will die a RCT is unethical.

    Second, the current treatment is to do nothing but palliative approaches. The proposed treatment is safe and effective. There is no way one could justify a RCT under these conditions. The question is just how effective. Read the doctors letter to Fauci and then see if you still want to make your comment.

    Efficacy and safety are not issues with HCQ + treatments. So why a RCT?

    My guess is that you do not read much because since you have been commenting here probably over a 100 links have been provided that would have pointed out the fallacy of this specific comment.

  9. 9
    JVL says:

    Jerry: The proposed treatment is safe and effective.

    It’s effectiveness against COVID-19 has not been adequately established. You can’t just assume that.

    The question is just how effective.

    A large majority of the studies have shown that it’s ineffective. And when RHolt answered some of your queries point by point you dropped the whole conversation.

    Efficacy and safety are not issues with HCQ + treatments. So why a RCT?

    Because safety and efficacy have not been shown. You choose to believe a few badly done trials but that doesn’t make them true.

    My guess is that you do not read much because since you have been commenting here probably over a 100 links have been provided that would have pointed out the fallacy of this specific comment.

    While you avoid dealing with any criticism of your own views?

  10. 10
    RHolt says:

    Jerry

    One is that several medical treatments have been established without an RCT

    That is quite interesting, Jerry. Would you supply us with a list of these treatments?

    Jerry

    in a case where several of the control group will die a RCT is unethical.

    not in the least.

    Jerry

    The question is just how effective

    As per your citation on the other thread the largest COVID-19 treatment facility in India. has stated that the use of HCQ (with or without AZ and zinc) has no efficacy in the treatment of COVID infected patients. The question has been answered.

  11. 11
    kairosfocus says:

    MMT,

    Months ago, I documented that there is an imposed hierarchy of empirical evidence on medical research regarding treatments; sometimes with quasi-legal force. I have also documented that, routinely, the hierarchy is used to discredit and dismiss inconvenient evidence, through selective hyperskepticism.

    In this case, that is happening where what we can rapidly have — fast enough to make a difference with a rapidly spreading novel, deadly disease — is case results by the thousands (with a consistent strong performance for HCQ cocktails used with vulnerable people early in the U/L trajectory).

    That is being dismissed in favour of experiments that are misdirected to too late in the trajectory, or to non-vulnerable groups, etc (as Prof Risch also points out above and in the onward linked). Those who are building biased to fail tests know or should know better.

    In the cases he notes, something slipped through the cracks, some vulnerable people, fairly late in trajectory . . . by survival rate . . . were treated and showed a relatively favourable result. That’s not plausibly mere coincidence once the other two factors are brought to bear. What we have is a pattern of testing that is biased to make HCQ cocktails seem to fail, but as soon as a crack opened, it worked instead. That is a significant sign of a fairly reliable natural regularity, strongly reflected in quite valid but too often dismissed evidence from thousands of cases.

    That backdrop being crucial in seeing that this is not a simple case of what are the odds of a sample looking one way or another by chance.

    No, it is, what are the odds, on

    a: the thousands of valid but disregarded cases and

    b: testing consistently biased to fail, that

    c: once a crack opened up, bang things worked as advertised.

    That’s a whole different ballgame.

    In this context, months have been lost and a lot more have died or suffered needless systemic damage than otherwise.

    Bias has had consequences, bad ones.

    KF

  12. 12
    kairosfocus says:

    RHolt, you are simply wrong, KF

  13. 13
    Mac McTavish says:

    KF@11, yes, I have been following along. However, I have not found your selective cherry-picking and hyper skepticism to be very compelling.

  14. 14
    RHolt says:

    KF

    RHolt, you are simply wrong

    Well that sure clears things up!

    How about: KF, you are simply wrong.

  15. 15
    kairosfocus says:

    Jerry, yup, also, the placebo based studies will predictably take too long for the course of a pandemic. That’s a systematic, built in bias to fail. And, it has already had that impact, direct and indirect. KF

  16. 16
    bornagain77 says:

    Dr. Harvey Risch was on the Ingraham Angle last night:

    Kamala Harris comes after ‘The Ingraham Angle’ over hydroxychloroquine
    https://video.foxnews.com/v/6181011503001#sp=show-clips

  17. 17
    kairosfocus says:

    RHolt, I have valid evidence being disregarded by those who are setting up tests that are biased to fail. After months that is no longer an accident. Something is seriously, systematically wrong. On that backdrop, turnabout rhetoric doesn’t work so well. KF

  18. 18
    RHolt says:

    KF

    the placebo based studies will predictably take too long for the course of a pandemic.

    Placebo-based studies have already been published laying waste to this claim.

    KF

    I have valid evidence being disregarded by those who are setting up tests that are biased to fail. After months that is no longer a accident. Something is seriously, systematically wrong.

    That is obviously your opinion but there are a lot of folks, myself included, who do not find this to be the case. There may be research studies being conducted (or have been conducted) where you disagree with the question being tested but that in no way invalidates the research let alone automatically promoting them to the realm of conspiracies.

  19. 19
    kairosfocus says:

    RHolt, I will not get into a back forth, other than to note that we are now about half year into an outbreak, which is precisely the point on delays. A full approvals process takes many months as you full well know. As for that’s your opinion, I could easily deadlock by saying so is your view. The problem is, there is ample evidence being suppressed, not least through repeatedly biased to fail studies over about six months and counting, which also goes to the delays problem. By the time this needless mess is sorted out, the key bulk of direct harm and induced economic damage will have long since been set in train. What I am now led to conclude, is that there are serious built in failures in the systems, starting with ethics and epistemology of placebo based testing in the face of a fast moving pandemic, compounded by further fallacies of setting up a too-late gold standard to selectively hyperskeptically dismiss good evidence we actually have had in hand in ever growing degree for months: actual case results. Where as I showed in the PS, OP, the material comparison is between business as usual and reasonable alternatives, not artificially constructed no effective treatment controls that expose patients to needless harm. And that’s not just some blog contributor out there, more than enough has been put into the current professional discussion on the point. KF

  20. 20
    kairosfocus says:

    PS: Let me again clip from those doctors who just wrote an open letter to Dr Fauci, from the earlier thread my OP was simply meant to provide some charts for:

    Open Letter to Dr. Anthony Fauci Regarding the Use of Hydroxychloroquine for Treating COVID-19

    By

    George C. Fareed, MD
    Brawley, California

    Michael M. Jacobs, MD, MPH
    Pensacola, Florida

    Donald C. Pompan, MD
    Salinas, California

    . . . . QUESTIONS REGARDING EARLY OUTPATIENT TREATMENT

    There are generally two stages of COVID-19 symptomatic infection; initial flu like symptoms with progression to cytokine storm and respiratory failure, correct?
    When people are admitted to a hospital, they generally are in worse condition, correct?
    There are no specific medications currently recommended for early outpatient treatment of symptomatic COVID-19 infection, correct?
    Remdesivir and Dexamethasone are used for hospitalized patients, correct?
    There is currently no recommended pharmacologic early outpatient treatment for individuals in the flu stage of the illness, correct?
    It is true that COVID-19 is much more lethal than the flu for high-risk individuals such as older patients and those with significant comorbidities, correct?
    Individuals with signs of early COVID-19 infection typically have a runny nose, fever, cough, shortness of breath, loss of smell, etc., and physicians send them home to rest, eat chicken soup etc., but offer no specific, targeted medications, correct?
    These high-risk individuals are at high risk of death, on the order of 15% or higher, correct?
    So just so we are clear—the current standard of care now is to send clinically stable symptomatic patients home, “with a wait and see” approach?
    Are you aware that physicians are successfully using Hydroxychloroquine combined with Zinc and Azithromycin as a “cocktail” for early outpatient treatment of symptomatic, high-risk, individuals?
    Have you heard of the “Zelenko Protocol,” for treating high-risk patients with COVID 19 as an outpatient?
    Have you read Dr. Risch’s article in the American Journal of Epidemiology of the early outpatient treatment of COVID-19?
    Are you aware that physicians using the medication combination or “cocktail” recommend use within the first 5 to 7 days of the onset of symptoms, before the illness impacts the lungs, or cytokine storm evolves?
    Again, to be clear, your recommendation is no pharmacologic treatment as an outpatient for the flu—like symptoms in patients that are stable, regardless of their risk factors, correct?
    Would you advocate for early pharmacologic outpatient treatment of symptomatic COVID-19 patients if you were confident that it was beneficial?
    Are you aware that there are hundreds of physicians in the United States and thousands across the globe who have had dramatic success treating high-risk individuals as outpatients with this “cocktail?”
    Are you aware that there are at least 10 studies demonstrating the efficacy of early outpatient treatment with the Hydroxychloroquine cocktail for high-risk patients — so this is beyond anecdotal, correct?
    If one of your loved ones had diabetes or asthma, or any potentially complicating comorbidity, and tested positive for COVID-19, would you recommend “wait and see how they do” and go to the hospital if symptoms progress?
    Even with multiple studies documenting remarkable outpatient efficacy and safety of the Hydroxychloroquine “cocktail,” you believe the risks of the medication combination outweigh the benefits?
    Is it true that with regard to Hydroxychloroquine and treatment of COVID-19 infection, you have said repeatedly that “The Overwhelming Evidence of Properly Conducted Randomized Clinical Trials Indicate No Therapeutic Efficacy of Hydroxychloroquine (HCQ)?”
    But NONE of the randomized controlled trials to which you refer were done in the first 5 to 7 days after the onset of symptoms- correct?
    All of the randomized controlled trials to which you refer were done on hospitalized patients, correct?
    Hospitalized patients are typically sicker that outpatients, correct?
    None of the randomized controlled trials to which you refer used the full cocktail consisting of Hydroxychloroquine, Zinc, and Azithromycin, correct?

    While the University of Minnesota study is referred to as disproving the cocktail, the meds were not given within the first 5 to 7 days of illness, the test group was not high risk (death rates were 3%), and no zinc was given, correct?
    Again, for clarity, the trials upon which you base your opinion regarding the efficacy of Hydroxychloroquine, assessed neither the full cocktail (to include Zinc + Azithromycin or doxycycline) nor administered treatment within the first 5 to 7 days of symptoms, nor focused on the high-risk group, correct?
    Therefore, you have no basis to conclude that the Hydroxychloroquine cocktail when used early in the outpatient setting, within the first 5 to 7 days of symptoms, in high risk patients, is not effective, correct?
    It is thus false and misleading to say that the effective and safe use of Hydroxychloroquine, Zinc, and Azithromycin has been “debunked,” correct? How could it be “debunked” if there is not a single study that contradicts its use?

    Should it not be an absolute priority for the NIH and CDC to look at ways to treat Americans with symptomatic COVID-19 infections early to prevent disease progression?
    The SARS-CoV-2/COVID-19 virus is an RNA virus. It is well-established that Zinc interferes with RNA viral replication, correct?
    Moreover, is it not true that hydroxychloroquine facilitates the entry of zinc into the cell, is a “ionophore,” correct?
    Isn’t also it true that Azithromycin has established anti-viral properties?
    Are you aware of the paper from Baylor by Dr. McCullough et. al. describing established mechanisms by which the components of the “HCQ cocktail” exert anti-viral effects?

    So- the use of hydroxychloroquine, azithromycin (or doxycycline) and zinc, the “HCQ cocktail,” is based on science, correct?

    Care to answer?

  21. 21
    jerry says:

    Kf,

    Let me again clip from those doctors

    They will not read. They have the actual link. They have the information. They are not here to move anything forward positively. They are here to nitpick and quarrel. When what they propose let’s people die as part of the process, they are not serious people nor moral ones.

    Arguing over the design of the universe and the process of evolution is one thing. But they reveal who they really are when they dispute obvious policies that will save lives. I have said for years it is not the science arguments that are interesting. They are. But it is the behavior of the people who dispute the arguments and why. We have here a different example of irrational arguments but this time it is to support the death of people. All they want to do is nitpick while people are dying. Very revealing.

    Information and rational arguments are like water to the Wicked Witch of the West in the Wizard of Oz. They must be avoided at all costs. Or else they and their ideas will melt away.

  22. 22
    kairosfocus says:

    Jerry, I think there is a fog of polarised controversy that blocks clarity. I took time to highlight blocks of questions posed by medical doctors on the record just above, in hope that there will be responsiveness. If after six months, there is unresponsiveness or there are misleading answers, that will speak volumes given what is at stake. KF

  23. 23
    RHolt says:

    KF

    we are now about half year into an outbreak, which is precisely the point on delays. A full approvals process takes many months as you full well know.

    True we are 6 months into the outbreak and in the time numerous trials have been approved and are being conducted. Some have been completed and published and others are either nearing completion or have ended with data being analyzed and publication being prepped. So I don’t see the impediment to doing properly conducted trials to elucidate the answers we need going forward. In the mean time patients are being treated with all manner of drugs and protocols outside of the controlled trial setting. I don’t see the conspiracies that you see but I do recognize the danger of not doing controlled trials due to the inherent weakness that is found in retrospective trials and certainly the profound weakness of relying on anecdotes. I guess I have a higher standard of evidence for efficacy that you and many others have. Likely because I know of the case history’s of drugs and/or chemical compounds that have been rushed to market or inadequately tested with dire patient outcomes as a result.

    KF

    As for that’s your opinion, I could easily deadlock by saying so is your view

    Of course you could which is kinda the point I was making.

    KF

    The problem is, there is ample evidence being suppressed, not least through repeatedly biased to fail studies over about six months and counting, which also goes to the delays problem.

    There yo go again! There is no evidence being suppressed. You, I and others have posted all manner of stuff…what is missing? Once again what I see is your disagreement with the research question that was being asked. Obviously, the researchers and the review boards found the question compelling enough to approve and conduct the study. The results are valid in the realm of the question that was being asked. Your disagreement over what you think they should be studying and what is actually studied doesn’t invalidate the research. it does convey your opinion that you think something else should have been studied. For example in my reading of past posts o this topic you were high supportive of the in vitro research done with green monkey kidney cells yet you raised no questions of why human tissue, and more specifically human lung tissue, were not used. You accepted the result of the study without question. One could wonder if it was a biased based acceptance since the results showed efficacy in HCQ’s antiviral properties. However, we now know that when human lung cells were tested in vitro with HCQ the results demonstrated that HCQ had no protective or antiviral properties in that cell line. I’ve yet to see you accept these results as robustly as you appeared to accept the green monkey cell line results.

  24. 24
    kairosfocus says:

    RHolt, rather than go through a string of exchanges, I simply challenge you to answer the questions posed to Dr Fauci. KF

  25. 25
    jerry says:

    I think there is a fog of polarised controversy that blocks clarity

    I don’t believe there is any fog. There is definitely polarization but no fog. The evidence is clear so there is no lack of clarity. What is happening is what is happening at large in all of society. There is a lack of good will on one side. It definitely is not healthy but it can not lead to anything positive.

    What the other side does not realize is that that the Montagnards alway destroy the Girondins.

  26. 26
    RHolt says:

    KF

    rather than go through a string of exchanges, I simply challenge you to answer the questions posed to Dr Fauci

    would you agree to a challenge of answering a similar number of questions from myself or anther source?

  27. 27
    kairosfocus says:

    RHolt, I infer you are likely to be a medical practitioner bound under Hipocratic principles, or at least you have presented yourself as having significant relevant knowledge enough to dismiss say the findings of Dr Didier Raoult of France. Who happens to be a major researcher on the subject with key published results. In that context it is fair to pose to you such questions (which suggest a pattern of answers, but invite public correction). So, let us see if you can substantiate your corrections. If you refuse, we can in all prudence conclude that what is being suggested by the questions and by those associated with them summarises a responsible and even credible but marginalised view on a public policy matter with sobering potential global consequences, not only medical but economic, social, policy, political and even geostrategic. KF

    PS: On decision theory linked issues relevant to placebo controls, onward I intend to use here, for reasons that will be apparent over the next day or so:

    https://www.nejm.org/doi/full/10.1056/NEJMra1614394

    Allow a clip from Frieden:

    Despite their strengths, RCTs have substantial limitations. Although they can have strong internal validity, RCTs sometimes lack external validity; generalizations of findings outside the study population may be invalid.2,4,6 RCTs usually do not have sufficient study periods or population sizes to assess duration of treatment effect (e.g., waning immunity of vaccines) or to identify rare but serious adverse effects of treatment, which often become evident during postmarketing surveillance and long-term follow-up but could not be practically assessed in an RCT. The increasingly high costs and time constraints of RCTs can also lead to reliance on surrogate markers that may not correlate well with the outcome of interest. Selection of high-risk groups increases the likelihood of having adequate numbers of end points, but these groups may not be relevant to the broader target populations. These limitations and the fact that RCTs often take years to plan, implement, and analyze reduce the ability of RCTs to keep pace with clinical innovations; new products and standards of care are often developed before earlier models complete evaluation. These limitations also affect the use of RCTs for urgent health issues, such as infectious disease outbreaks, for which public health decisions must be made quickly on the basis of limited and often imperfect available data. RCTs are also limited in their ability to assess the individualized effect of treatment, as can result from differences in surgical techniques, and are generally impractical for rare diseases.

    Many other data sources can provide valid evidence for clinical and public health action. Observational studies, including assessments of results from the implementation of new programs and policies, remain the foremost source, but other examples include analysis of aggregate clinical or epidemiologic data.

  28. 28
    RHolt says:

    KF

    I infer you are likely to be a medical practitioner bound under Hipocratic principles, or at least you have presented yourself as having significant relevant knowledge enough to dismiss say the findings of Dr Didier Raoult of France.

    you, certainly, are free to infer whatever you wish. doesn’t mean you are correct only that you have that freedom. we all know things. Some of us know more about some things than others. That is true for me and it is true for you.

    In that context it is fair to pose to you such questions (which suggest a pattern of answers, but invite public correction)

    you are assuming your inference is correct. What if you are wrong/mistaken? Is it still fair to ask me questions while giving yourself amnesty on questions of the subject matter?

    So, let us see if you can substantiate your corrections.

    I’ve substantiated all. ‘corrections’ I’ve made on this forum. Mostly by citing relevant research or posting out basic knowledge, e.g., pharmacokinetic and pharmacodynamic principles.

    If you refuse,

    and what should be inferred if your should refuse to answer a series of questions on the subject matter posed to you? I’m not inclined to answer a series of questions on your demand if you refuse to have your own feet held ‘to the fire’ with a similar series of questions. Why would I or anyone do something you refuse to do yourself?

  29. 29
    kairosfocus says:

    RHolt, we can summarise that you need to therefore address the following methodological questions:

    QUESTIONS REGARDING METHODOLOGY:

    In regards to the use of hydroxychloroquine, you have repeatedly made the same statement: “The Overwhelming Evidence from Properly Conducted Randomized Clinical Trials Indicate no Therapeutic Efficacy of Hydroxychloroquine.” Is that correct?
    In Dr. Risch’s article regarding the early use of hydroxychloroquine, he disputes your opinion. He scientifically evaluated the data from the studies to support his opinions. Have you published any articles to support your opinions?
    You repeatedly state that randomized clinical trials are needed to make conclusions regarding treatments, correct?
    The FDA has approved many medications (especially in the area of cancer treatment) without randomized clinical trials, correct?
    Are you aware that Dr. Thomas Frieden, the previous head of the CDC wrote an article in the New England Journal of Medicine in 2017 called “Evidence for Health Decision Making — Beyond Randomized Clinical Trials (RCT)?” Have you read that article?
    In it Dr. Frieden states that “many data sources can provide valid evidence for clinical and public health action, including analysis of aggregate clinical or epidemiological data.” Do you disagree with that?
    Frieden discusses “practiced-based evidence” as being essential in many discoveries, such SIDS (Sudden Infant Death Syndrome). Do you disagree with that?
    Frieden writes the following: “Current evidence-grading systems are biased toward randomized clinical trials, which may lead to inadequate consideration of non-RCT data.” Dr. Fauci, have you considered all the non-RCT data in coming to your opinions?
    Risch, who is a leading world authority in the analysis of aggregate clinical data, has done a rigorous analysis that he published regarding the early treatment of COVID-19 with hydroxychloroquine, zinc, and azithromycin. He cites five or six studies, and in an updated article there are five or six more, a total of 10 to 12 clinical studies with formally collected data specifically regarding the early treatment of COVID. Have you analyzed the aggregate data regarding early treatment of high-risk patients with hydroxychloroquine, zinc, and azithromycin?

    Is there any document that you can produce for the American people of your analysis of the aggregate data that would rebut Dr. Risch’s analysis?
    Yet, despite what Dr. Risch believes is overwhelming evidence in support of the early use of hydroxychloroquine, you dismiss the treatment insisting on randomized controlled trials even in the midst of a pandemic?
    Would you want a loved one with high-risk comorbidities placed in the control group of a randomized clinical trial when a number of studies demonstrate safety and dramatic efficacy of the early use of the hydroxychloroquine “cocktail?”
    Are you aware that the FDA approved a number of cancer chemotherapy drugs without randomized control trials based solely on epidemiological evidence? The trials came later as confirmation. Are you aware of that?
    You are well aware that there were no randomized clinical trials in the case of penicillin that saved thousands of lives in World War II? Was not this in the best interest of our soldiers?
    You would agree that many lives were saved with the use of cancer drugs and penicillin that were used before any randomized clinical trials, correct?
    You have referred to evidence for hydroxychloroquine as “anecdotal,” which is defined as “evidence collected in a casual or informal manner and relying heavily or entirely on personal testimony,” correct?
    But there are many studies supporting the use of hydroxychloroquine in which evidence was collected formally and not on personal testimony, has there not been?
    So, it would be false to conclude that the evidence supporting the early use of hydroxychloroquine is anecdotal, correct?

    I have already linked Frieden, with a clip that goes to the heart of the issues, especially as they point to decision-making.

    KF

  30. 30
    RHolt says:

    KF

    These limitations also affect the use of RCTs for urgent health issues, such as infectious disease outbreaks, for which public health decisions must be made quickly on the basis of limited and often imperfect available data.

    Correct me if I am wrong but isn’t that exactly what has happened? HCQ and the associated cocktail has been administered to thousands and thousands of patients sans completed trials. As well drugs such as ivermectin, interferon, ribavirin, peptides, and others have been used w/o the results of RCT data. doesn’t mean that the RCT should not be conducted and we should continue on using drugs willy nilly based on, often, anecdotal reports of efficacy. Confirmation is required at some point in time and as has been pointed out RCT have been, and are being conducted with a number of research questions being asked and tested.

  31. 31
    RHolt says:

    kf,

    we can summarise that you need to therefore address the following methodological questions:

    Explain to me why I need to address those questions? What about the questions I’ve posed to you that have been studiously ignored? I’ve made no demands of you and feel everyone answers or participates at the level they wish based on any number of factors, e.g., time and inclination.

    I am a mere participant here as you are even less so given your moderating capabilities. I am more than willing to have a discussion on any published literature as should be obvious by now. I am not so inclined to be subject to, demands I answer anything if you aren’t going to hold yourself to the same standard.

  32. 32
    kairosfocus says:

    PS: And your projection card fails. I have engaged and substantiated issues of ethics, epistemology and decision making as informed by evidence and analysis, including by world class experts. Indeed you just saw my reference to Dr Raoult and to Dr Frieden, the OP is about Dr Risch, and these are pointing to precisely the pattern of gold standard fallacy, selective hyperskepticism, resort to biased to fail tests extending over several months, and more. Further to this, in an exchange this day, you misrepresented the balance on merits regarding concerns regarding placebo controlled tests, note what Dr Frieden has stated. In short, I am not in your position at all and we have every right of prudence to draw strong conclusions regarding your evident response once the public questions to Dr Fauci were on the table. Which, in aggregate, amply rebut your claimed substantiations, if what they suggest is not substantially falsified. KF

  33. 33
    RHolt says:

    kf

    And your projection card fails.

    Projection? I am only asking that you treat me as you wish to be treated.

    I have engaged and substantiated issues of ethics, epistemology and decision making as informed by evidence and analysis, including by world class experts.

    I feel the same way.

    misrepresented the balance on merits regarding concerns regarding placebo controlled tests

    How so? What have I misrepresented?

  34. 34
    kairosfocus says:

    RHolt, I have already shown the substantial record I have made, which puts us in very different conditions. The enabling import of your evasion is therefore taken. KF

    PS: I clip some further questions that are in some ways even more revealing:

    While some doctors may not want to use the drug, should not doctors who believe that it is indicated be able to offer it to their patients?
    Are you aware that doctors who are publicly advocating for such a strategy with the early use of the HCQ cocktail are being silenced with removal of content on the internet and even censorship in the medical community?
    You are aware of the 20 or so physicians who came to the Supreme Court steps advocating for the early use of the hydroxychloroquine cocktail. In fact, you said these were “a bunch of people spouting out something that isn’t true.” Dr. Fauci, these are not just “people,” these are doctors who actually treat patients, unlike you, correct?
    Do you know that the video they made went viral with 17 million views in just a few hours, and was then removed from the internet?
    Are you aware that their website, American Frontline Doctors, was taken down the next day?
    Did you see the way that Nigerian immigrant physician, Dr. Stella Immanuel, was mocked in the media for her religious views and called a “witch doctor?”
    Are you aware that Dr. Simone Gold, the leader of the group, was fired from her job as an Emergency Room physician the following day?
    Are you aware that physicians advocating for this treatment that has by now probably saved millions of lives around the globe are harassed by local health departments, state agencies and medical boards, and even at their own hospitals? Are you aware of that?
    Don’t you think doctors should have the right to speak out on behalf of their patients without the threat of retribution?
    Are you aware that videos and other educational information are removed off the internet and labeled, in the words of Mark Zuckerberg, as “misinformation?”
    Is it not misinformation to characterize hydroxychloroquine, in the doses used for early outpatient treatment of COVID-19 infections, as a dangerous drug?
    Is it not misleading for you to repeatedly state to the American public that randomized clinical trials are the sole source of information to confirm the efficacy of a treatment?
    Was it not misinformation when on CNN you cited the Lancet study based on false data from Surgisphere as evidence of the lack of efficacy of hydroxychloroquine?
    Is it not misinformation as is repeated in the MSM as a result of your comments that a randomized clinical trial is required by the FDA for a drug approval?
    Don’t you realize how much damage this falsehood perpetuates?

  35. 35
    kairosfocus says:

    RHolt, on placebos you have a clip and a paper to address. Note Dr Frieden’s concerns. Kindly note just what he formerly headed, the US CDC. KF

  36. 36
    jerry says:

    Kf,

    I am going to post a number of things on the other thread since this is about Dr. Risch. If anything is pertinent to Risch’s arguments I will post them here. But right now going to dinner.

  37. 37
    kairosfocus says:

    Fine. Enjoy your dinner!

  38. 38
    Bob O'H says:

    kf @ 4 – I guess I should congratulate you on derailing this thread. My comment wasn’t about RCTs, it was a criticism of Risch’s statistical competence: he appears not to understand confidence intervals, multiple testing, or even that when adverse effects are reported, that means that there are adverse effects.

    The nearest to a criticism of what I wrote was this:

    Then, you twisted

    Every randomized controlled trial to date that has looked at early outpatient treatment has involved low-risk patients, patients who are not generally treated. In these studies, so few untreated control patients have required hospitalization that significant differences were not found. There has been only one exception: In a study done in Spain with low-risk patients, a small number of high-risk nursing home patients were included. For those patients, the medications cut the risk of a bad outcome in half.

    . . . into almost its opposite by way of a confidence interval (where chance factors would be most unlikely to be flat-distributed).

    I reject the accusation that I twisted what Risch wrote: I made absolutely no attempt to re-interpret what he wrote. Rather I said that what he wrote was wrong and misleading: the results in the original study don’t support his claim, because they’re too uncertain. Your comment doesn’t address that point.

  39. 39
    Bob O'H says:

    Jerry @ 5 – fair enough, I did mis-read sentence.

  40. 40
    kairosfocus says:

    B O’H: it is fair and relevant comment that you have failed to see the real context, projecting statistical ignorance instead, as I have already noted. I add to that a note that classically, science is about recognising natural regularities. There is a body of credible work (one, supported above by the import of the questions raised by an open letter to Dr Fauci and that of the 2017 article of a former US CDC Director on the need to go beyond placebo controlled studies) that shows that HCQ based cocktails can and do regularly produce dramatic improvements for early U/L trajectory, high risk group, not yet hospitalised patients, leading to avoiding complications and sharply reducing death rate. This, in defiance of sound epistemology and inductive logic (as well as ethics issues tied to placebos in the face of fast killing pandemics . . . up to 15% of highly vulnerable groups), you have chosen to dismiss or marginalise. In that context, you have failed to duly note how many negative result studies are biased to fail, creating a misleading perception. In the context of some studies, one happened to include a vulnerable sub population, from the results, fairly late in the U/L trajectory. Just a crack but, bingo, there is an effect in line with the body of cases we know of otherwise, even though attenuated. In that context, the ACTUAL result is what counts and fits a wider context pointing to a natural regularity at work. This frames a very different epistemological evaluation than you suggested, for cause. It also points to institutionalised, ingrained biases that will require mindset change and new approaches going forward. KF

  41. 41
    PaV says:

    From around the world, and, notably, in Washington DC, there have been doctors who have come out into the spotlight to let people know that HCQ is working, that it saves lives.

    Can I ask the skeptics of HCQ here this question: How many doctors have come out into the spotlight telling us that Remdevisir is saving lives? I’m not aware of a single instance. Yet, the great, white epidimiologist Dr. Fauci said of Remdisivir that it’s effects are “significant.” And, of course, it WAS a double-blind study. What more do you need than that?

    And what was “significant” about Remdesivir? Why it reduced your time recovering (if you recover) from 14 days to 11 days! Does it “save” lives? Not really. There’s really no evidence that it saves anybody.

    Again, where are the press conferences, where are the doctors taking center stage to tell us how great this drug is? Is it because this is a “do-nothing” drug that will make the NIH money and make Gilead a bundle and no more?

    In the meantime, we’ve had people left and right tell us that they think HCQ saved their lives. Has anyone said, “Remdesivir saved my life!” I don’t know of any.
    But I guess doctors and patients attesting that HCQ works and saves lives is nothing more than–in the words of the most high and mighty Dr. Fauci, “anecdotal evidence.”

    So lives are being lost. Dr. Fauci has overseen our country’s HIV policies for nearly 35 years. The entire enterprise is scientifically bankrupt. And his handling of CoVid has been scientifically bankrupt.

  42. 42
    PaV says:

    Here’s something from a Fortune article on Remdesivir:

    Without wading too deep into the mathematical weeds, what this generally means is that comparing percentages of patients who die with one therapy versus another treatment course isn’t the be-all and end-all of a treatment’s effectiveness. You can lower a death rate from 10% to 8%. That’s technically a 20% relative reduction; but on an absolute level, you still have 8% of people dying.

    In Gilead’s case the company claims that for patients being treated with remdesivir, after 14 days the mortality rate fell to 7.6% versus 12.5% for those being treated with existing standard-of-care options.

    That’s a noticeable difference. But the nuances persist, as stated by experts in Gilead’s own press release. The study was not randomized (meaning, it pitted different data pools together, which can lead to discrepancies), and there wasn’t a placebo arm to test true efficacy on the mortality front.

    So, I was wrong. It wasn’t a double-blind study. And it wasn’t randomized. But it was good enough for Dr. Fauci. Yes, sir, Gilead gives money to the NIH. Yes, sir, I see something “significant” here, but it isn’t Remdesivir’s effectiveness.

  43. 43
    PaV says:

    Here we find that remdesivir reduces death by 30%. Yes, from 12.76 % to 7.6%. But they’re simply quoting Gileads report. And, of course, there are problems with their numbers as the last post indicates.

    Here is an article/TV report from a doctor involved in the Remdesivir studies that shows a 62% improvement in “severe” CoVid patients. This really would be “significant,” but it is not what Gilead has reported and it is difficult to know how the comparisons were done to reach this 62% improvement. We also don’t know what the absolute numbers are, only the percentage improvement.

    Lastly, if HCQ were used from the onset, then maybe there wouldn’t be so many “severe” cases. There’s two stages of this disease: HCQ is for the first part and Remdesivir for that latter. If Remdesivir is working, then ‘thanks be to God’ for that. However, again, where are the press conferences? Where are the doctors touting this drug? I don’t see them out there.

    I did a search and only three articles showed up. Not overwhelming praise, I would say.

  44. 44
    PaV says:

    From “Fool.com”:

    Why investors may be underwhelmed
    Gilead released additional data on remdesivir’s effectiveness in treating COVID-19 on July 10. That data indicated that 74.4% of patients who were taking remdesivir recovered from COVID-19 by the 14th day, compared with 59% of patients who recovered when receiving the current standard of care. For every 1,000 patients, that’s 154 more that will recover by day 14 when taking remdesivir, compared with those patients who aren’t taking the drug.

    It’s a modest improvement, but what’s clear is that remdesivir is not the silver bullet many people were hoping it would be to stop COVID-19 in its tracks. What may be most disappointing about the data is that one of the factors that Gilead identified as being “significantly associated with clinical improvement” was whether a patient was under the age of 65. Seniors are the most vulnerable to COVID-19 and its effects. Data from New York City Health indicated that as of May 13, people 65 and over made up three-quarters of COVID-19 deaths in the city.

    Remdesivir is effective in helping to treat some patients with COVID-19, but it likely isn’t going far enough (especially in helping seniors) to justify a five-day treatment cost of $2,340 — and that’s the discounted price for governments and veterans. The price for insurance companies is 33% higher and comes in at $3,120 for an individual patient.

    So, if you’re not so much at risk, Remdesivir works. Good to know.

  45. 45
    PaV says:

    British Medical Journal, July 31, 2020:

    Evidence from this living systematic review and network meta-analysis suggests that glucocorticoids probably reduce mortality and mechanical ventilation in patients with severe covid-19. Remdesivir probably reduces length of hospital stay. The effects of most drug interventions are currently highly uncertain, and no definitive evidence exists that other interventions result in important benefits and harms for any outcomes.

    Not exactly a ringing endorsement for Remdesivir.

  46. 46
    PaV says:

    The Lancet:
    <Findings
    Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95–2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early.
    Interpretation
    In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits. However, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies./i>

  47. 47
    PaV says:

    I’ve found what I could about remdesivir. Is it any wonder that there are no doctors coming forward to laud the effectiveness of this drug? Yet, they’re doing so for HCQ. Yes, I know, it’s “anecdotal.”

  48. 48
    Bob O'H says:

    kf @ 40 –

    B O’H: it is fair and relevant comment that you have failed to see the real context, projecting statistical ignorance instead, as I have already noted.

    Does this mean that you accept my narrow point that Risch mislead his readers, but that it’s OK because of the wider issue?

    I add to that a note that classically, science is about recognising natural regularities.

    True. But it’s also about making sure you don’t mistake randomness for regularities. Because that’s very easy to do.

  49. 49
    kairosfocus says:

    PaV, interesting. You may find the onward thread on Dr Thomas Frieden’s suggestions on research interesting. In response to exchanges, I found and appended a discussion on mechanism of action for HCQ etc. That may help refocus discussion. KF

  50. 50
    kairosfocus says:

    BO’H:

    in principle — and esp on a quasi-infinite multiverse — we may freely default that every apparent regularity we see is in fact happenstance bound to happen in some population of parallel worlds somewhere; so much for the strict logical rigour of statistical reasoning. The issue therefore cannot be disproving chance but rendering it implausible relative to natural regularities in one direction and intelligent design in another.

    Thus, we have a core worldviews commitment antecedent to any further reasoning on possibility of cause through mechanical necessity or intelligent design. In effect, at root level, we reject the everything reduces to chance in a quasi-infinite multiverse thesis, and hold that it is reasonable to see chance, necessity and design in action.

    On which, we then address some form or other of a differential inference filter, often viewed from the design inference perspective.

    Thus (I will add to the OP — and also on HCQ mechanisms) we rake mechanical necessity as default [to explain low contingent outcomes on closely similar start points]. Next, where there is high contingency instead, we see blind chance and/or insightful intelligent design. To differentiate the two, we plausibly expect to see patterns sufficiently close to randomness influenced models if a particular aspect is to be explained on chance, the second default.

    We experience ourselves as designers, unless you are going to the self-referential incoherence of grand delusion. By analogy, we see similar creatures as designers and on various grounds may extend to other possible beings within or beyond the cosmos up to God. So, we can directly observe or note historical record on some cases of design. From this, we detect clusters of reliable signs of design, such as FSCO/I, language, algorithms, complex mechanisms with many required mutually adapted parts not plausible on chance, etc.

    So, we routinely conclude that say text in comments is designed though we do not observe one another. (I did meet UD’s President, once.)

    Now, we come to science, which clearly is well beyond being applied statistics.

    It is in that context that I draw your attention to the just linked addition on casual mechanisms. This, together with the observation that once opportunity opened, cocktails worked, is a far better explanation in context than your dismissal on statistical grounds as though we have no reason otherwise to expect it to work. And it is not misleading to point out the fact.

    KF

  51. 51
    PaV says:

    KairosFocus:

    I’m not trying to derail the discussion, rather I’m pointing out the obvious: viz., those treating patients attest to the effectiveness of HCQ. Scholarly retorts to the one side, remdesivir is not being hailed,while HCQ is. In the remdesivir studies, they note that HCQ used in conjunction with remdesivir interferes with its effectiveness. This data in no way detracts from HCQ’s tremendous success in early treatment. Your chart above highlights this difference in utility, but, again, does not detract from HCQ’s great utility early on. This should be obvious to all.

  52. 52
    kairosfocus says:

    PaV, it SHOULD be obvious, but then it SHOULD be clear what the source of alphanumeric, string data structure codes, algorithms and execution machinery is. Even, when we see such in the living cell. KF

  53. 53
    PaV says:

    Defective syllogisms!

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