Doctor Ivette Lozano from Dallas, Texas on treating patients with HCQ Cocktails

Dr Zelenko speaks out again https://uncommondesc.wpengine.com/medicine/dr-zelenko-on-israel-national-news-may-21-2020-forthcoming-paper-two-weeks/ kairosfocus

Jerry, I think we are seeing impacts of how a paradigm or plausibility structure lock schools of thought into an overton window that locks out what would be obvious to an outsider. Hence Dr Zelenko saying but isn't it standard to treat a disease as early as possible, so why the strange difference here? He makes a comparison to how a fire can flash over into a much more dangerous stage and notes how much easier it is to hit it while it is small. He identifies that by the time people are at a Doctor's office they are likely to be about day 5 in the disease process, on the verge of an explosion in viral load with attendant damage. He estimates turnaround time at about 3 days on tests, thus if you wait you likely have had serious damage due to explosion in viral load with attendant cell destruction to produce those viruses; linked doubtless, is immune respone which can spin out of control in a potentially fatal cytokine storm. He points to manageable toxicity and safety then suggests, go on the drug cocktail, then pull back if there is no need. In short, he is prioritising cost effectiveness of clinical diagnosis. KF kairosfocus

But what you actually wrote was nonsense to anyone but a mind-reader

More nonsense. I have made probably a couple hundred comments on C19 since late March when I found out about Zelenko and his approach. All have been consistent arguing for early intervention and nearly no opinion on what works after hospitalization. One has to be obtuse to not know what I have been advocating. Or not reading my comments or the links I posted. If the latter then one should refrain from criticizing what I write. A large percentage of my comments refer to a treatment for C19 advocating zinc and that HCQ is effective as an ionophore. But for early usage. Maybe I talked about HCQ as a possibility for late stage treatment but if I did it wasn’t emphasized. Since I am not a major advocate of HCQ by itself as the way to treat the virus. I constantly advocate for zinc. But I have pointed to other treatments that have promise. Because I believe the way out of this mess is effective early treatment. Eventually most will have to get the virus to effect immunity. Shutdowns, social distancing and masks are possibly just postponIng the inevitable. However, while not a major advocate of HCQ by itself, I find it interesting that numerous countries are using HCQ with success. I also find the criticisms of Raoult specious. And most of the countries that aren’t Using HCQ are having problems. Three good examples are France, UK and United States. jerry

Was the Lancet study cooked? The most interesting part of the study implies giving HCQ exacerbates the effect of the virus not by causing cardiac problems but by causing oxygen and breathing problems. There ie a very high correlation between ventilator usage and HCQ. This could happen in a couple ways. HCQ causes the virus to become more virulent necessitating ventilation. Or those requiring ventilation who are much more serious were more likely to receive HCQ as a last resort. This happened to my friend. I bet he is in study. He was early March in New York area. Maybe others. But I bet the later hypothesis has merit. I know that supposedly HCQ was administered early where it was administered (Just over 11% of patients got it) but unless each patient is examined to see the progression and prognosis at administration we will not know. Why do NYU study and Lancet study differ so much? Quercetin Is also thought to possibly be an ionophore. There is a study on it going on right now at Magill and possible effect on C19. jerry

F/N: Quercetin is an anti oxidant, anti-inflammatory flavenoid commonly found in fruit, vegetables etc, which in part acts to help mop up free radicals https://www.healthline.com/nutrition/quercetin#what-it-is KF kairosfocus

BO'H, you have a point, though it is clear Jerry has been emphasising intervention early in the U, to avert need for hospitalisation to address the seriously damaged body at increased risk of death. I add, it is plausible that fairly strong drugs will have differing toxicity impacts at different stages of the descending arm of the process. Where, I repeat from the old prof in my uni: Pharmacology is the study of poisons in small doses. In this case, I suspect the disease damaged body has steadily decreasing LD50 as damage accumulates. That means the window of effectiveness between dosage/kg and LD50 is steadily narrowing, raising further questions of retention period/persistence in the body. BTW, drunkenness is an early toxic effect as is getting high on many drugs. I have already noted on the fat soluble nature of THC in marijuana and the implications of steady use. Certain anesthetics depend on that solubility to affect myelin sheaths of nerves but can have retentions on the scale of decades, giving a sort of flashback episode effect. LSD seems to be of similar character, based on its notorious flashback effects. The point is, toxicity is a complex challenge hence part of why physician management based on background knowledge and specifics of the patient . . . as opposed to attempted micromanagement by bureaucrats and politicians who do not, cannot, understand unintended consequences and the level of complexity of a society and economy . . . is key. KF kairosfocus

EG, I am saying that "tests" is not to be conflated with then -- per gold standard fallacy" -- reduced to laboratory tests. I am further saying, that all the tests: of reporting and record [reduced to files], of observation in the Office and/or on an examining table, through sampling and testing by instruments or by lab work, fall under the same inductive logic of inferring based on signs. (BTW, post C S Peirce, we can extend this to responding to text etc.) In the context of CV19, records and reports on medical history identify vulnerable groups, a cluster of reported symptoms and observed signs allows clinical differential diagnosis on a systematic procedure all physicians are taught, this being amplified by the context of pandemic. Further to such, as Raoult, Zelenko, Lozano et al demonstrate with up to 90+% reduction of case fatalities . . . see OP . . . prompt treatment high up the U with a by now known effective and low cost cocktail is a reasonable intervention, even as tests are done using swabs etc. The root of this being that the virally influenced body, through the clash of disease process and immune system, will exhibit clusters of signs manifesting the process at work. However, predictably, objectors to design inferences on adequate signs will struggle far more widely with other such inductive inferences that do not fit the current progressivist narrative. KF kairosfocus

Jerry @ 270 - if you weren't including more serious patients when you made that comment, you should have said. But what you actually wrote was nonsense to anyone but a mind-reader. Bob O'H

Acartia Eddie:

How does Joe explain them to his wife (sister, mother, aunt)?

I explain [SNIP -- return shot] ET

You can treat the flu and covid-19 with the following kit: Emergen-C- Take 1-2 per day. If symptoms arise take 2 @ a time twice a day Cell Power- As directed. Increase if symptoms occur Vitamin D3- take up to 5000 IU’s/ day- this needs to be started months ago so get on it. D is fat soluble. Quercetin- As directed ZMA- As directed Zinc Sulfate- Use to increase total zinc to 90 MG/ day if symptoms arise That’s the basics.

Thanks...

You are welcome, Acartia. My family knows of its effectiveness with respect to the flu. The science supports it with respect to covid-19. Just because you are too stupid to think for yourself doesn't mean the rest of us have to be so handicapped. My kit will save lives. And I am more than OK with that. ET

Jerry

abstinence

I agree. [SNIP -- needless personal attack of slanderous character.] Ed George

What do you prescribe for Genital warts?

abstinence jerry

ET

You can treat the flu and covid-19 with the following kit:

Thanks Dr. Joe. What do you prescribe for Genital warts? Ed George

You can treat the flu and covid-19 with the following kit: Emergen-C- Take 1-2 per day. If symptoms arise take 2 @ a time twice a day Cell Power- As directed. Increase if symptoms occur Vitamin D3- take up to 5000 IU's/ day- this needs to be started months ago so get on it. D is fat soluble. Quercetin- As directed ZMA- As directed Zinc Sulfate- Use to increase total zinc to 90 MG/ day if symptoms arise That's the basics. ET

Are you seriously suggesting that doctors can diagnose, prescribe and effectively monitor this workload outside of hospitals?

No problem. There are just under a million doctors in the US. And about 180,000 nurse practitioners and physician assistants. While not all would be treating C19 patients there will be more than enough to test and treat everyone in the US. Remember most will not require treatment or even need to be tested. They would actually do it much more efficiently than hospitals. Hospitals would not be needed except for severe cases which should be few. jerry

It might actually be worse than that, Ed. In Aus and NZ they use a sentinal system for self-reporting flu-like symptoms (cough, running nose, fever etc) to get an early warning of local epidemics etc. As well as the amazing effect of lockdowns this year, it looks like ~2% of the population report these symptoms each week (admitedly during the sourthen cold and flu season) https://www.newcastle.edu.au/media/viewer?media=616557 2% symptomatic * 330 million people = about 6 million people to triage per week This is not a random sample, so there are possible biases etc, but gives you an idea of the prevalence of the mild symptoms. orthomyxo

KF, you keep saying that doctors can diagnose and treat COVID-19 without the need for extensive testing or hospitalization. Let’s do the math. Number of GPs in the US: <12,000 Number of confirmed COVID cases: 1,700,000. Number of COVID patients per GP: 141. OK. Doesn’t sound so bad. What disease initially presents itself similar to COVID? Number of reported flu incidents per year: -45,000,000 per year. Number of flu + COVID per year: 46,700,000. Number of flu + COVID per GP. 3,891. Are you seriously suggesting that doctors can diagnose, prescribe and effectively monitor this workload outside of hospitals? Ed George

This is just nonsense.

No your comment is nonsense. You are referring to late stage patients and I am referring to normal usage as a prophylactic and initial stages of the virus. Given that this study is inappropriate this study and the NYU study on HCQ and zinc show very different results. jerry

Jerry, the issue with diagnostic "tests" is that we are dealing with inductive inference on signs. When a doctor observes us coming into his office, watches our faces, sees how we breathe, the pupils of our eyes, those are already several signs. Tongue, throat, voice, pulse rate and strength, sound of the heart and many other things are signs that in context tell a story independent of reported symptoms. Here is the clincher: blood tests, ECG's etc are ALSO inferences on sign, so the issue is really the extent and types of tests, not the presence of tests.And of course determined objectors to the design inference are always going to have trouble with inferences on signs. KF kairosfocus

BO'H, the conflation of two very different points on the U leads to a serious error here. Given at the right time, high enough up on the U -- as Raoult's numbers and those of others show -- the cocktail reduces fatality rates by up to 90+ percent. Lower down the curve, with damage already there, it is plausible that such fairly serious drugs have a very different impact. We must not mistake beach death apples for crab apples. KF kairosfocus

Jerry -

The side effects are minimal for HCQ. No one has provided any extensive lethal side effects from using it for C19.

This is just nonsense. That's exactly what the paper in The Lancet did. There was a higher death rate in people treated with HCQ. It was quite literally extensive (over 6 continents, with thousands of patients), and lethal (more people died). Bob O'H

I guess since you didn’t answer my question, that means that there are no tests that can tell if a patient in the early stages of COVID-19 will progress to a more serious case or will recover.

No test exists and I doubt if such tests exists for most diseases. So I do not understand what the concern is. What the doctor can do is diagnose the patient clinically for the virus if an actually quick test is not available. There is usually a high correlation with successful diagnosis. As rapid tests become more available the need for clinical evaluations alone will not be as necessary. A doctor can often diagnose the severity of an illness by the intensity of certain symptoms such as temperature, redness of throat, severity of coughing, blood counts or indications of air blockages etc. Just remember what a doctor does when he examines a patient. He goes through a progression of tests to determine what is not normal. Zelenko divided his patients into high and low risk based on their chances of being affected severely by the virus. This was done by reported progressions with others. High risk patients were given the treatment. Low risk patients were observed because nearly all will defeat the virus with their immune system. This was delineated above and at other places several times. If symptoms progress for the low risk patients, then they are moved into high risk and given the treatment. You really should go to the links for Zelenko and listen. It will answer most of your questions. The side effects are minimal for HCQ. No one has provided any extensive lethal side effects from using it for C19. See the CDC handout for this drug for potential exposure to malaria for anyone. It is used as a prophylactic. My wife and I were given it before going to Africa 6 years ago. https://bit.ly/2LYTPdZ So your objections are specious. There is always the possibility of something going wrong with any treatment or drug (aspirin, ibuprofen and acetaminophen all come with warnings) but we have the other side with a high percentage of people dying from lack of treatment. There should be minimal concern. People seem to be grasping for anything negative when there is little there. My guess is that if Trump had not said anything about HCQ there would be thousands of news articles reporting his irresponsibility for not advancing a potential cure. jerry

BO'H: you are conflating diagnostic tests of observation and reporting with lab tests then excluding the former through the gold standard fallacy. Jerry and I have both pointed out your error. As far as testing those who have sufficient indications that it would be wise to do so, both he and I also pointed to such. KF kairosfocus

kf - if what I said was false, please quote the part of Jerry's post where he describes the diagnostic test for whether a patient will get worse or not. Bob O'H

BO'H: false, likely due to the gold standard fallacy used to dismiss otherwise competent evidence. Jerry did answer your question, based on 2400 years of medicine, that clinical diagnosis is a first filter that is effective in identifying at risk candidates for treatment and those for whom concerns on toxic effects would be significant, in early stages of the U. Confirmatory tests are just that.I add, note, there is no feasibility of testing the population every two weeks or the like, just from the logistics involved. In any case, in early stages, damage would be minimal, the drugs are under physician supervision and are cheap. So, an early intervention is likely to be successful in averting damage requiring hospitalisation even as the immune system mobilises to destroy the infection with low risk of breaking out of control into a cytokine storm. Actually, HCQ is an anti-inflammatory also. Take that with in vitro results, plausible mechanisms and case studies and we can see why there are reports of significant effectiveness. The notion that you kill more than you cure is empirically refuted by the Raoult study, as clipped above and which currently is even stronger. We must not compare crab apples to beach death apples. KF kairosfocus

Jerry @ 251 - I guess since you didn't answer my question, that means that there are no tests that can tell if a patient in the early stages of COVID-19 will progress to a more serious case or will recover. This is an important problem if you're advocating for using HCQ as a treatment in the early stages. We know there are side effects (from the long history of its use), and that it can be lethal (from the Lancet study, albeit that is in patients with a more severe disease progression). If you are going to give it to patients who will recover anyway, you might end up killing more people than you'll cure. This is especially problematic as you'd be treating a lot of people who wouldn't need it, so it would have to have a big effect on those who would need it if it's to be effective. Fortunately there is a trial to test this. Bob O'H

EG, an obviously politicised organisation, its announcements have to be carefully parsed and balanced. The evidence as we have tracked still stands on its own merits; once one is so far down the U that one is in hospital care, likely a lot of damage has already been done . . . likely to vulnerable people. The target zone for successful use of the cocktail is early in the course of the disease, preventing damage that leads to needing serious hospital based care; as Jerry has repeatedly pointed out. Where, vulnerable people with lung and likely cardiovascular system damage will plausibly, likely be less able to handle drug toxicity. Yet again, drugs are poisons in small doses. In short the situation is not simple. Also, you have yet to take back some intemperate remarks above i/l/o my step by step response in 199 above. I add, you need to also respond to Jerry's and my comments on relevant early stage patients i/l/o Zelenko et al, cf. 247 on. There are other points of unresponsiveness as well. KF PS: I add, there was some suggestion that other macrolides or doxycycline could be used in cocktails https://clinicaltrials.gov/ct2/show/NCT04370782 BTW, macrolide action of blocking the P site in ribosomes through a reversible bond would reduce protein synthesis, which would plausibly inhibit virus hijacking of the cellular machinery. I cannot find back a doctor's report on use of I think it was doxycycline in place of azithromycine. kairosfocus

WHO cancels HCQ testing over safety risks. https://apple.news/APzivcvQ-S72_wVjsw1oUcA Ed George

Whatever RH7. ,, The virus is far less deadly than originally predicted. Frankly, I think someone needs to develop a vaccine for your, and the News media, fear mongering. For middle age. it is no worse than the seasonal flu. Youngsters are barely effected at all. The elderly and those with preconditions are the ones who have to be extra careful. Per Fox News at 5 pm today - Ed Henry interview bornagain77

inflammation in tissues throughout the body increases with age, a fact that helps the coronavirus get into the body, bind to molecules in the nose and lungs, and wreak havoc, Janet Lord, director of the Institute of Inflammation and Ageing at the University of Birmingham in England, explained in a webinar this month. Fat tissue, for example, increases inflammation and renders overweight people more vulnerable to a COVID infection. Skeletal muscle helps the immune system,” Lord said. The contractions of skeletal muscles produce small proteins called myokines that, by dampening inflammation, have big health benefits. Myokines ferret out infections and keep inflammation from getting out of hand, she said. Also, exercising skeletal muscle helps diminish body fat and increases the potency of natural killer cells no matter what your age. An 85-year-old who increases muscle mass is better able to recover from COVID, she said. The more extensive or vigorous the exercise, the less inflammation, Lord said. She noted that those who do fewer than 3,000 steps a day have the highest level of inflammation, whereas those who do 10,000 or more steps daily have the least inflammation. https://www.nytimes.com/2020/05/25/well/live/to-fight-covid-19-dont-neglect-immunity-and-inflammation.html rhampton7

Let’s pray this result isnt true for Coronavirus.... Human coronavirus reinfection dynamics: lessons for SARS-CoV-2 n the current SARS-CoV-2 pandemic a key unsolved question is the quality and duration of acquired immunity in recovered individuals. This is crucial to solve, however SARS-CoV-2 has circulated for under five months, precluding a direct study. We therefore monitored 10 subjects over a time span of 35 years (1985-2020), providing a total of 2473 follow up person-months, and determined a) their antibody levels following infection by any of the four seasonal human coronaviruses, and b) the time period after which reinfections by the same virus can occur. An alarmingly short duration of protective immunity to coronaviruses was found by both analyses. We saw frequent reinfections at 12 months post-infection and a substantial reduction in antibody levels as soon as 6 months post-infection. https://www.researchgate.net/publication/341467148_Human_coronavirus_reinfection_dynamics_lessons_for_SARS-CoV-2 rhampton7

“those middle-aged adults who go to church, synagogues, mosques or other houses of worship reduce their mortality risk by 55%.”

Can attending church really help you live longer? This study says yes – June 1, 2017 Excerpt: Specifically, the study says those middle-aged adults who go to church, synagogues, mosques or other houses of worship reduce their mortality risk by 55%. The Plos One journal published the “Church Attendance, Allostatic Load and Mortality in Middle Aged Adults” study May 16. “For those who did not attend church at all, they were twice as likely to die prematurely than those who did who attended church at some point over the last year,” Bruce said. https://www.usatoday.com/story/news/nation-now/2017/06/02/can-attending-church-really-help-you-live-longer-study-says-yes/364375001/ Study: Religiously affiliated people lived “9.45 and 5.64 years longer…” July 1, 2018 Excerpt: Self-reported religious service attendance has been linked with longevity. However, previous work has largely relied on self-report data and volunteer samples. Here, mention of a religious affiliation in obituaries was analyzed as an alternative measure of religiosity. In two samples (N = 505 from Des Moines, IA, and N = 1,096 from 42 U.S. cities), the religiously affiliated lived 9.45 and 5.64 years longer, respectively, than the nonreligiously affiliated. Additionally, social integration and volunteerism partially mediated the religion–longevity relation. https://uncommondesc.wpengine.com/intelligent-design/study-religiously-affiliated-people-lived-religiously-affiliated-lived-9-45-and-5-64-years-longer/ Can Religion Extend Your Life? - By Chuck Dinerstein — June 16, 2018 Excerpt: The researcher's regression analysis suggested that the effect of volunteering and participation accounted for 20% or 1 year of the impact, while religious affiliation accounted for the remaining four years or 80%. https://www.acsh.org/news/2018/06/16/can-religion-extend-your-life-13092 Atheism and health A meta-analysis of all studies, both published and unpublished, relating to religious involvement and longevity was carried out in 2000. Forty-two studies were included, involving some 126,000 subjects. Active religious involvement increased the chance of living longer by some 29%, and participation in public religious practices, such as church attendance, increased the chance of living longer by 43%.[4][5] http://www.conservapedia.com/Atheism_and_health “I maintain that whatever else faith may be, it cannot be a delusion. The advantageous effect of religious belief and spirituality on mental and physical health is one of the best-kept secrets in psychiatry and medicine generally. If the findings of the huge volume of research on this topic had gone in the opposite direction and it had been found that religion damages your mental health, it would have been front-page news in every newspaper in the land.” - Professor Andrew Sims former President of the Royal College of Psychiatrists - Is Faith Delusion?: Why religion is good for your health - preface https://books.google.com/books?id=PREdCgAAQBAJ&pg=PR11#v=onepage&q&f=false “In the majority of studies, religious involvement is correlated with well-being, happiness and life satisfaction; hope and optimism; purpose and meaning in life; higher self-esteem; better adaptation to bereavement; greater social support and less loneliness; lower rates of depression and faster recovery from depression; lower rates of suicide and fewer positive attitudes towards suicide; less anxiety; less psychosis and fewer psychotic tendencies; lower rates of alcohol and drug use and abuse; less delinquency and criminal activity; greater marital stability and satisfaction… We concluded that for the vast majority of people the apparent benefits of devout belief and practice probably outweigh the risks.” - Professor Andrew Sims former President of the Royal College of Psychiatrists - Is Faith Delusion?: Why religion is good for your health – page 100 https://books.google.com/books?id=PREdCgAAQBAJ&pg=PA100#v=onepage&q&f=false Of snakebites and suicide - February 18, 2014 RESULTS: Religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects who endorsed a religious affiliation. https://uncommondesc.wpengine.com/intelligent-design/of-snakebites-and-suicide/

bornagain77

The North Carolina Department of Health and Human Services is reporting the highest number of hospitalizations so far in the pandemic. Currently, 627 people are hospitalized in the state due to complications from COVID-19. That’s up 40 from Sunday. Still, 28 percent of inpatient beds and 22 percent of ICU beds in the state are available. An additional 742 cases were reported on Monday, bringing the total to 23,964. https://www.wwaytv3.com/2020/05/25/nc-sees-highest-number-of-hospitalizations-since-start-of-the-pandemic-as-state-enters-first-full-week-of-phase-2/ rhampton7

Mendocino County (CA) public health officials said Sunday that six more people who participated in a Mother’s Day service at Assembly of God Church in Redwood Valley contracted the virus, raising the number of cases to nine and making the outbreak responsible for a third of local infections. Meanwhile, Butte County health officials said two of 180 people who attended a Mother’s Day church service in Oroville have tested positive for COVID-19. They said a recent spike in local cases, mostly in the Oroville area, indicate increased community spread. https://www.nbcbayarea.com/news/california/2-church-services-sources-of-virus-outbreaks-officials/2296360/ rhampton7

Seven members of Evangelical Ebenezer’s congregation have tested positive; all members of the congregation are aware of their exposure, and are currently being contacted for testing. All members of the congregation have also been given instructions to quarantine until they receive a negative test result; those who test positive will be given isolation orders for 14 days. In addition, church leadership has been provided disinfection guidance. This brings Macon County (NC) to a total of 16 positive cases: 13 active, 2 recovered, and 1 death. MCPH is working to identify additional close contacts of these individuals. The CDC defines close contact asbeing within approximately 6 feet of a person with an infection with COVID-19 case for a prolonged period oftime of 10 minutes or longer. https://smokymountainnews.com/news/item/29158-covid-19-cluster-identified-in-macon-church rhampton7

MONTGOMERY, Ala. (WSFA) - Over the last two to three weeks, hospitals in Montgomery have seen an alarming number of COVID-19 patients come through their doors. “We’ve really seen an influx of patients with COVID-19 over the past two to three weeks,” said Dr. Lisa Williams, a Pulmonary Critical Care Specialist at Baptist Medical Center South. “Our ICU beds are full. We’ve been having a lot of overflow in the ICU.” Williams said she has never seen this many patients coming into their hospital in such a short period of time. https://www.wsfa.com/2020/05/25/doctor-baptist-south-out-icu-beds-er-treating-patient-overflow/ rhampton7

Are diagnostic tools to do this available?

Most definitely. Most C19 people exhibit a progression of symptoms from none to pneumonia and difficulty breathing symptoms. There are other symptoms in between which generally indicate a progression to the more severe symptoms. If they have no symptoms, then they are let go and no one will test them even though they have the virus especially if they are in the low risk group. Zelenko defines the low risk group as anyone under 60 with no comorbidities. If they are older and have no symptoms then they are also not tested. The next group are those that have mild symptoms such as a cough and a fever but are otherwise robust. They are also not tested and not treated if they are in the low risk group because most defeat the virus. In the high risk group they will be given the treatment if they have additional symptoms such as difficulty breathing and will be tested. Otherwise they will be monitored to see how they progress. All on an out patient basis. If they have mild but have more severe cough and fever and shortness of breath, they will be given the treatment immediately. Usually this relieves the symptoms in a short time. Zelenko would diagnose his patients clinically and test as best as he could but tests were limited and took 3 days to get back. So he prescribed the treatment that cost less than $10. Nearly everyone recovered and only 4 out 1500 needed hospitalization though 2/3 of these 1500 were low risk. I believe 4 went to the hospital and two died. He has not posted any recent statistics and has been busy classifying every patient based on anti bodies as to whether they had the virus. He is preparing his stats for publication. In most doctors offices, when one is diagnosed, they will not be given any treatment. If they don't recover then they will eventually be hospitalized when there usually be no treatments either against the virus but amelioration of symptoms only. As we have seen, a small percentage of hospitalizations were given HCQ or some combination at this stage with no marked improvement. Those given zinc in addition had a higher chance of survival. A good doctor will have no problem identifying someone who is likely to have the virus and then prescribe the treatment at an early stage. The treatment is inexpensive and With a little effort enough for the world could be produced. The treatment are pills that cost a penny or two to produce in bulk. It also appears that about a third of the people may carry an anti-body to the virus from previous exposures to other corona viruses which is why many are not affected. MedCram investigated that today,. Too early to tell anything here. All this should be common knowledge if one had been following the discussions. jerry

EG, I suggest you see my just now remark to BO'H. Jerry at 247 may also help. KF kairosfocus

BO'H: it is impossible to do a PCR test on the entire population, much less every five to fourteen days. Accordingly, the feasible option is to identify the symptomatic and vulnerable groups, then treat early. Testing seems to have somewhat of a speed/accuracy tradeoff. In that context, the cluster of effective treatments can significantly reduce hospitalisation for severe progress of the disease while immune systems defeat the virus. Long run, there may be a vaccine but as RNA viruses almost by definition rapidly mutate, I would not bet the farm on that. In the yet longer term, milder strains will likely outcompete the more aggressive ones and we will have another form of the common cold. In the meanwhile follow-on waves are to be expected. We may be dealing with this disease in fairly aggressive forms for a few years, judging by past pandemics. KF kairosfocus

People who are asymptomatic are by definition not at risk. Most will be that way.

But how do you distinguish between those and those who will later develop a more severe disease? Are diagnostic tools to do this available? Bob O'H

Then you fall into the same trap that KF has fallen into. If the treatment is required very early in its infection process now you must have a means of identifying these people

You have just demonstrated that you don’t understand the virus and its progression. Maybe you should read more before commenting. There is no problem identifying people at risk or then treating them at early stages. There is more than enough resources for the entire world. And the some. There’s also other combinations of treatments at latter stages after hospitalization to help. But the objective is to avoid hospitalization. People who are asymptomatic are by definition not at risk. Most will be that way. jerry

Jerry

The main reason for this is the fake new narratives put out by much of the world press especially the US press. If the country had followed the protocol of Zelenko and Trump, probably most of these people would be alive and so would most of those who died around the world.

Then you fall into the same trap that KF has fallen into. If the treatment is required very early in its infection process now you must have a means of identifying these people. Most people are asymptomatic in these very early stages and don't seek medical help. Add to this the fact that we do not have enough testing capacity to test even a low percentage of the population. You may be able to ramp up production of the test kits but you still have the limiting factors of qualified people to take the swabs and qualified people to perform the tests. Trump can't just snap his fingers and increase the number of qualified medical personnel. In spite of throwing huge amounts of resources at the testing issue, the US has tested less than 5% of the population in three months. If HCQ only works at very early stages, which appears to be the last refuge for those touting its curative powers, we must have an effective means of identifying the vast majority of infections at this early stage. We don't have that. The only fallback, therefore, would be to prescribe it to everyone as a prophylactic. To do this safely, weeding out those with conditions that would make taking it dangerous, would require the resources necessary to take take and interpret medical histories for everyone. Resources that we do not have. Not to mention the fact that there is already a shortage of HCQ, and that people would have to continue to take HCQ until the virus disappears, or a vaccine is found. Ed George

Obviously a down trend reflects that people get sick, get worse and may die, the up trend being if they recover.

oh, so you are just saying that people get worse, and then if they survive they get better! Why didn't you simply answer that yes, that's what you meant when I asked? it would have cleared things up straight away, without me puzzling about what you were trying to say, and what the relevance of the meaning of a Halls of residence was.

The more interesting issues have to do with what drives turning points and what can force an early upturn.

OK, so you're saying what's interesting is why some people recover and others don't. I agree. Bob O'H

BO'H, if you cannot make sense out of what I said already, I can do little to help you. Obviously a down trend reflects that people get sick, get worse and may die, the up trend being if they recover. The more interesting issues have to do with what drives turning points and what can force an early upturn. KF kairosfocus

kf @ 239, 240 - Now you've got that out of your system, I'll repeat my question

Trend in what? Are you just saying that people get worse, and then if they survive they get better?

You could just answer "yes" or "no" to the second question, and then I'll understand what you're on about. Bob O'H

Sadly, it looks like the US will hit 100,000 COVID-19 deaths tomorrow. Not quite the Memorial Day anyone wanted to see.

The main reason for this is the fake new narratives put out by much of the world press especially the US press. If the country had followed the protocol of Zelenko and Trump, probably most of these people would be alive and so would most of those who died around the world. jerry

Kf, Bob O’H has revealed that he understands little about this virus, has read little about it, reads few if any links provided and just repeats fake negative news he found someplace. It is similar with others here. jerry

BO'H: but, isn't a graphic picture using a familiar shape not notoriously a very effective way to communicate a trend line, inviting a more dynamics-driven, causal factor oriented understanding . . . with turning points highlighted? Or, is that too right brained a way of thinking? KF PS: At more sophisticated level, disease process modelling https://link.springer.com/article/10.1007/s40495-016-0066-x kairosfocus

BO'H: It has been on the table here for many weeks, that Pharmacology is the study of poisons in small doses. That phrase was the standard introduction by a notorious prof in Med in my Uni, we used to spot that first lecture in Hall of Residence [not, "dorm" . . . more like Fraternity] by the subdued mood of bright and shiny new med students (just like the shock of their first Anatomy lab). In effect, EVERY drug is toxic . . . and so is "every" spice and so are surprisingly many foods (e.g. Jamaica's Ackees, half of the National Dish) . . . so the issue is immediate and cumulative dosage and somatic load. Hence, dangers of fat soluble active factors like THC in ganja and hence cumulative lead poisoning. Hence, too, drink plenty fluids. Yes, HCQ is toxic and yes by their very name antibiotics are literally "against life." The issue is balanced management so we gain benefits as early as possible in the U process, promoting early recovery before more damaging and potentially catastrophic phases set in. That process requires expert intervention and supervision, hence the well-known role of a licensed physician. I am disappointed but not surprised to see the way toxicity of HCQ cocktails is being spun by the agenda-driven media and such like, exploiting failure to understand significance of where one is along the disease U. KF kairosfocus

BO’H, pardon but the U model has been on the table for weeks here at UD.

I'm sorry, but this was the first I had seen of it.

The idea is that a fast-mover disease like this triggers a U-shaped trend (with a potentially catastrophic descending arm), where the crisis is the bend.

Trend in what? Are you just saying that people get worse, and then if they survive they get better? Bob O'H

BO'H, pardon but the U model has been on the table for weeks here at UD. The idea is that a fast-mover disease like this triggers a U-shaped trend (with a potentially catastrophic descending arm), where the crisis is the bend. Those who fail to make it, unfortunately die . . . a reverse J as the rising arm has been frustrated. Recovery then takes an onward period so recovery statistics lag death statistics, part of the epidemiologist's headaches. Of course, relapses can move us to a W . . . double U . . . etc. So, we have a simple descriptive model of the trend of such an illness. [This is similar to the plucking model of recession in economics.] The stitch in time factor is, to hit the process early in the descending arm, so the U is shallow; you will probably recall the question of building up one's "resistance" to colds, Flu and the like. In the context of Ivermectin, its preliminary indication is that it can help to pluck back up from further down the descending arm. And of course hospitalisation is an index of being fairly far down the arm, ICU being a yet worse sign. Intubation and Ventilation are grim signs. KF kairosfocus

Jeery @ 226 - Thanks. I wondered if it was something like that. But, as you point out, most people in the early stages have mild symptoms, and they won't get worse. As you know, HCQ has side effects, and can be fatal (as the Lancet paper shows). I don't know if the side effects will be as bad in milder cases, but isn't it something to be worried about? If you give a treatment with fatal side effects to people who won't need it? Bob O'H

EG, first, EVERY doctor in the world is trained in a standardised, global diagnostic system originally developed in C19 - 20. In turn, that rests on longstanding inductive inference on signs [think, Hippocrates of Cos, yes, that far back]. You will doubtless recall the standard profiling that is taken down by nurses and by the physician maintaining a file, and how blood pressure, heart rate and the like are commonly taken. In turn, that rests on the principle of identity, here, for the human being influenced by an internalised alien agent triggering a disease process. Such is here influenced by a known context of pandemic, which dramatically shifts priors in conditional probabilities. What Jerry describes is eminently feasible, from early phases; indeed frontline physicians have been highlighting key clusters of symptoms and signs. In the pandemic context, such then point to locus and trajectory relative to the U, hence indications on best action. Over-dependence on lab tests as gold standard -- here we go yet again -- is not a healthy sign. Further to this, the evidence is that early intervention with a cocktail makes a difference; and we have preliminary results noted above pointing to things that reach further down the descending leg of the U. Jerry indicates that modification with OTC supplements is an option for civilians trying to fortify their basic resistance. Sanitisers, personal protection, distancing and in case of highly vulnerable, isolation can make a difference. KF PS: The US is indeed going across one of the magic numbers that can have considerable rhetorical impact; which will predictably be exploited and trumpeted. My perception on such is modified forever by the comparison of a cluster of countries in Europe. Also, by recognition that perhaps 2/5 is in the Hudson River estuary zone and neighbouring areas, with a strongly intersecting 2/5 being nursing home residents. Which was manifest from the very first headlined cluster in was it Washington State. Once pandemic broke out of Wuhan and set up lodgements, grim consequences were sure to follow especially in densely populated urban zones, of which the Hudson River bay zone is one of the biggest in the world. The issue then became a race between epidemic and implied deaths from isolation and its damaging economic and social impacts, leading to the dismal calculus of minimising deaths. In that calculus, painful errors are inevitable, the key test is responsiveness and learning. Onward, the expectation is a series of further waves, hopefully we can manage them better. kairosfocus

kf @ 219 -

Bo’H, late stage is far down the U descending leg.

This is utterly meaningless, because "U descending leg" is meaningless unless you explain what the "U descending leg" is. Are you able to explain it without jargon? Bob O'H

Sadly, it looks like the US will hit 100,000 COVID-19 deaths tomorrow. Not quite the Memorial Day anyone wanted to see. Ed George

KF

kindly note the above.

Sorry, but if mass produced tests are limited, what do you think the limitations are associated with skilled diagnosticians? How many are there in the US? How many people can they see a day. You recently posted an excellent OP on scale within the solar system but are completely blind to scale within society. The US has 337,000,000+ people and 335,700 clinical lab technicians. And with this number they are stretched beyond capacity because of COVID-19 (obviously Not all are trained on COVID-19 testing protocol). And you are suggesting that testing isn’t necessarily required, that skilled diagnosticians can diagnose COVID-19 with a high degree of accuracy, without testing. And I accept this as true. But if the 335,700 technicians aren’t sufficient using a test that only takes minutes of manpower, how are the 9,000 infectious disease doctors in the US (not all qualified for corona viruses) going to fill in this gap? Ed George

Operations have been halted at the world's deepest operational mine after more than one-quarter of COVID-19 tests given to those who work there produced positive results. AngloGold Ashanti said Sunday that it had stopped work at the Mponeng gold mine in South Africa after learning of the 650 tests it has administered since May 14, 164 were positive and "a handful" have yet to be processed. The "vast majority" of those who tested positive had not shown any symptoms of COVID-19, the company said. Contract tracing has been taking place through data from an electronic tracking system normally used to locate miners who go missing. Ed George

RH7, I now think masks are complicated, especially as significant numbers struggle to breathe right in them for hours on end day by day. I think that that struggle is cumulative and may be debilitating. For sure, hard physical work becomes more challenging. KF kairosfocus

Jerry, thanks. I add, Zelenko reported that clinical diagnosis on key signs was about 90% right. EG, kindly note the above. Such has been discussed in fair detail across weeks. Now, set in the context of the U model, which BTW implies a crisis of life and death as things head down. A familiar, grim pattern. KF kairosfocus

If the HCQ treatment must be used at very early stages, how do you identify the people with new infections?

This indicates that you have not been reading or looking at links provided. Zelenko went over in detail what he has done. He would test as best as he could because tests were limited and took 3 days to get results. But he would diagnose clinically everyone who showed symptoms as well as test those in what he called the high risk group. He divided the population into two groups, high risks which was anyone over 60 or younger than 60 with a comorbidity such as diabetes or heart problem. He would also classify as high risk anyone showing symptoms such as shortness of breath. For the low risk patients he would send them home with instructions to monitor themselves and report back any worsening. Thus, he over diagnosed but since his treatment was very inexpensive and harmless, there was nothing lost. His last reported figures were out of over 400+ confirmed with C19 there has been 2 deaths and four hospitalizations, since released and two intubations both of which came off of it. There is no need to test everyone but those in the high risk category who have symptoms. It is not hard to get a test these days if you have a prescription and some come back in a. couple hours. So diagnosing early is most definitely possible and not an issue. The object is to not get to the hospital and Zelenko has done that almost 100% with his patients. So these tests done in hospitals are invalid for evaluating HCQ as a treatment in early stages. I suggest you watch the MedCram videos to learn about the virus and some of Zelenko's videos are still up in places. Google has made it their policy to remove anything to do with zinc. They even took down one of MedCram's videos on zinc. It's one of the top medical sites in the world. Here is a podcast interview with Zelenko that Google could not take down https://bit.ly/2XrYwlL jerry

North Dakota Gov. Doug Burgum became emotional Friday as he pleaded with residents not to divide themselves over mask wearing amid the coronavirus pandemic or shame those who choose to wear masks, but to instead be empathetic. "I would really love to see in North Dakota that we could just skip this thing that other parts of the nation are going through, where they're creating a divide -- either it's ideological or political or something -- around mask versus no mask," Burgum, a Republican, said during a news conference Friday in Bismarck. "This is a, I would say, senseless dividing line." He urged people to "try to dial up your empathy and your understanding." https://www.kbzk.com/news/coronavirus/north-dakota-governor-makes-emotional-plea-to-avoid-divide-over-face-masks rhampton7

What do you mean by “late stage”?

The virus proceed in stages. At first there are little or no indications that anything is wrong. In fact most never get past this stage and their immune system eliminate the virus. This is usually the first 5 days. Then there is a stage where there are mild symptom such as coughing and these can progress to something more severe with in this stage such as shortness of breath. Again the immune system may beat the virus but the more susceptible should be treated at this stage with HCQ, zinc and azithromycin. This has nearly 100% effect of defeating the virus. This is usually less than 12 days. Then if not treated the patient will start to develop pneumonia like symptoms or other symptom of lung damage. This usually starts about 12 days after infection if not treated or the immune system does not defeat the virus. This is when hospitalization is prescribed. This is what seems to be when the Lancet study is saying the patients were being diagnosed. At this point the virus is well established and something like HCQ is less likely to have an effect. This seems to be what is being presented in the Lancet study,.

And how is this relevant to cases outside the US?

Two thirds of the studies were from North America which mainly means the US. There is also no indication that the testing was any different outside the US so all could be late stage studies and irrelevant. Your questions indicate you do not understand what this disease is about. I suggest you visit the MedCram site. It will be very informative. jerry

Ohio Gov. Mike DeWine says wearing masks while in public during the coronavirus pandemic should not be a political issue but is about people acting to protect others. “ This is not about politics, this is not about whether you’re liberal or conservative, left or right, Republican, Democrat," he said. “... You wear the mask not to protect yourself so much as to protect others. And this is one time when we truly are all in this together. What we do directly impacts others." “As we go out, a lot of stores you’ll see 90% of the ... customers are wearing masks," the Republican governor said. “But we want to continue to up that throughout the state because it is really what we need as we open up the economy." https://abc6onyourside.com/news/local/ohio-governor-wearing-masks-shouldnt-be-political-issue rhampton7

KF

EG, there has been ample discussion for weeks. The point Zelenko made so forcefully is obvious, stomp on it early and you avert the cascade down the U, especially if you fit a vulnerability profile.

Again, you are evading the obvious question, that I have asked twice already. . If the HCQ treatment must be used at very early stages, how do you identify the people with new infections? Do you test everyone? Every couple weeks until the virus is gone? We can barely keep up with testing people who show any symptoms. My career has been in the testing field. I can assure you that you can’t just flip a switch and dramatically increase testing capacity. If it were that easy we would be testing far more than a low single digit percentage of the population. Since we can’t rely on testing to effectively identify people with early infections, we would have to rely on providing it as a prophylactic to everyone, probably on an ongoing basis until the virus is gone. How do you propose that we do this with a drug that is already in short supply. Ed George

Missouri overcounted the number of people it claimed have been tested for COVID-19 by at least 17,000, state health officials said Saturday, raising the percentage infection rate and muddying the state’s assessment of the viral spread even as regional officials ease restrictions. Until Saturday, health officials were lumping together two different types of tests: viral tests that show who is currently sick with COVID-19, and antibody tests that look for signs of past exposure. Meanwhile 148,303 people have been tested for active COVID-19 infections, DHSS said. Of those, 11,751 people, or 7.9%, tested positive. The department previously reported that as of May 21, 172,946 viral tests for active COVID-19 infections had been done, and 11,340 people — or 6.5% — had tested positive. https://www.stltoday.com/news/local/state-and-regional/missouri-among-states-overcounting-coronavirus-testing-blurring-picture-of-virus-spread/article_1f520733-7d60-56ff-89ea-34965ec48f28.html rhampton7

A second Missouri hairstylist who showed up for work at a salon earlier this month while exhibiting coronavirus symptoms may have exposed as many as 56 clients, health officials said. On Saturday, officials said that another symptomatic hairstylist at the Great Clips salon in Springfield may have exposed up to 84 customers and seven coworkers while working for eight days between May 12 and May 20. The Springfield-Greene County Health Department said that both hairstylists and their clients were wearing face coverings. “It is the hope of the department that because face coverings were worn throughout this exposure timeline, no additional cases will result,” the department said. Officials said they are tracking down everyone who was potentially exposed and advising them to watch for symptoms. https://www.thedailybeast.com/second-infected-missouri-hairstylist-in-springfield-may-have-exposed-56-clients-to-coronavirus rhampton7

A high school pool party “everybody thought was harmless” has fueled a second peak of coronavirus cases in Arkansas, Gov. Asa Hutchinson said Saturday. “A high school swim party that I’m sure everybody thought was harmless,” Hutchinson said at a press briefing, a video shows. “They’re young, they’re swimming, they’re just having activity, and positive cases resulted from that.” Hutchinson did not say how many people attended the party or subsequently tested positive for the COVID-19 virus. He called the incident “just an encouragement for us to be disciplined in our activities.” https://www.star-telegram.com/news/coronavirus/article242967096.html rhampton7

EG, there has been ample discussion for weeks. The point Zelenko made so forcefully is obvious, stomp on it early and you avert the cascade down the U, especially if you fit a vulnerability profile. Hence, a stitch in time. But then YT etc took down his message, predictably. Raoult is comfortably isolated behind language barriers. And the like. What we are seeing with that note discussed in 197 - 8, is that there are things that may help pull back up from further down the U. It seems once you need intubation or go on a ventilator, things are not favourable at all. KF kairosfocus

Bo'H, late stage is far down the U descending leg. The US is a good slice of the pandemic and dominates global discussion. Note, please the issues pointed out in 199, KF kairosfocus

kf @ 215 - I asked you to explain clearly. I guess that was a waste. You ignored 2 of my questions, and gave an almost incomprehensible answer to the third. §t may help to pull up people further down the descending leg of the U" What the **** is the U? I have absolutely no idea what you're on about. Bob O'H

Jerry @ 213 -

These are hospitalized patients which usually means they are In the late stage of the infection.

What do you mean by "late stage"?

In the US it was nearly impossible to get a valid test done till early March. Even then it would take a lot of time. The CDC screwed up big time on testing. So my guess is that these tests were not done early in the progression of the disease.

And how is this relevant to cases outside the US? The Lancet paper uses data from 6 continents, and finds a consistent pattern across them all. Bob O'H

KF, you have not addressed how we decide who to give this cocktail to. If it is only effective at the very early stages of infection, before any significant symptoms appear, how do we identify these people? Especially given the problems we have had in testing capacity. Ed George

BO'H, kindly see Jerry. I already noted point by point at 199 above. Ivermectin is a new twist as Jerry linked and I clipped and commented on at 197-8 . It may help to pull up people further down the descending leg of the U, i.e. the pattern points to incremental and marginal effects making the difference with survival. KF kairosfocus

EG, predictably, the turnabout game continues. While Jerry has addressed some good points just above, I add . . . and note the medicine category traces much of what will again come up. The truth is, cases are not a good direct metric of infections, there is a variable lag to onset of symptoms, averaging 5 days but 14 days is a conventional good enough upper limit. From onset of symptoms again it is variable but the talk is of the U, with deaths being those who cannot make the recovery bend. About 10 days seems a conventional average IIRC a physician in New Orleans who put notes up online early in the crisis. Vulnerable groups obviously tend to deteriorate faster and would find it harder to recover. Note the remarks above on suddenness of collapse. There is talk of a pyramid (I tend to think, iceberg), with techniques used to estimate the hidden profile of an epidemic, e.g. with the annual Flu season. Once enough key data is in hand, links to demographic profiles can be and are made. Epidemiological models can be calibrated. Usually, post epidemic. In that context, the HCQ cocktail is about stopping the downslide early. If that happens, you tend not to get hospital admissions, as opposed to outpatient basis or the like. That is where we can do tea blend calculations on say Raoult's numbers and see the difference in accumulative deaths. The new twist suggests that adding Ivermectin could reach further down the descending leg, once things have not reached to intubation or ventilators and obviously cytokine storms etc. I sure hope that pans out. Remdesivir, obviously, has some effect. Many other drugs are being tried. The caricature that HCQ cocktails poison people needs to be moderated. Start with, why would doctors resort to potentially controversial remedies listed as compassionate or emergency use. And more. But then, we are getting a good look at how people tend to think and form opinions. With fatal disaffection now looming over the horizon. KF kairosfocus

What “stitch in time effect” when all patients in the study were treated within 48 hours of diagnosis

These are hospitalized patients which usually means they are In the late stage of the infection. Not clear when the evaluation/diagnosis took place but if was after the patient exhibited severe symptoms then it was not appropriate to evaluate HCQ. In the US it was nearly impossible to get a valid test done till early March. Even then it would take a lot of time. The CDC screwed up big time on testing. So my guess is that these tests were not done early in the progression of the disease. They may have also been confirmatory tests done by the hospital after the patient was admitted. I have a friend who contacted the disease in early March but didn't get tested right away and was hospitalized with pneumonia before being diagnosed in the hospital. He was eventually given HCQ and survived. Have no idea if this was a typical episode but there was little testing outside of hospitals at first. The term “stitch in time” refers to avoiding serious trouble if a preventive is done early. It’s an old English expression. The other analogy being used is that of using a fire extinguisher to put out a fire when a small fire is found in a room. But a fire extinguisher is useless when the house is ablaze. jerry

kf @ 208 -

You have again failed to look at the context: the stitch in time effect, and even more directly, how ivermectin has shown early indications in vitro and in clinic.

What context? What "stitch in time effect" when all patients in the study were treated within 48 hours of diagnosis? And what does ivermectin have to do with this? Please explain clearly. Bob O'H

KF, not turnabout, just astute observation. There are many criticisms of Raoult‘s methods so I am not going to go into all of them. But one that jumps out to me is that there is no way of knowing how long after initial infection the treatments started. Given that we now know that the vast majority of cases are minor and often asymptomatic, we don’t know how many of his subjects already had declining viral loads. Maybe HCQ is very effective if administered early but this is only going to be effective if you test everyone, or administer it to everyone. Given that testing capacity is such that most countries are still limiting testing to those who are symptomatic and to health care workers, how do you propose to test everyone? At present, the US has only performed 43,750 tests per million. This would appear to be approximately 4% but the true per capita testing is much lower than that because many people (positives, essential workers, Anyone near Trump) receive multiple tests. Administering it to everyone is just not feasible, and extremely dangerous given it’s possible side effects. Ed George

EG, turnabout projection, while dodging the force of the point by point discussion correcting errors of sample framing, fact [as in, controls and of what type], inference and more, as well as the earlier article. Not unexpected, but underscoring what has been going wrong. KF kairosfocus

KF

EG, evasion again. KF

Yes, you have been repeatedly evasive, but I didn’t want to be the one to bring it up. Ed George

BO'H: You have again failed to look at the context: the stitch in time effect, and even more directly, how ivermectin has shown early indications in vitro and in clinic. But then, all of this is helping us to understand how, too often, we address controversial, polarised matters. And, it isn't pretty. The political operators of course are well aware of such issues and happily manipulate them. We are heading to fatal disaffection. KF kairosfocus

JVL- Proteins are not static, they vibrate. Look it up. Said vibrations can change the structural form of the protein. ET

PS: And yes, I am pointing to something new that is beginning to climb the ladder of cumulative evidence, from in vitro to now early off label cases with a promising result.

You may think that more people dying when they are given a drug than when they aren't (after correcting for other differences that might affect the outcome) is a promising result, but that's going to be a difficult sell. Bob O'H

BO'H: The abstract implies that these are hospitalised, obviously serious cases, and are delayed relative to the target zone for the cocktail. The point is to hit early and prevent cases from moving to the point of needing hospitalisation or facing the rapid collapse that is warned of. Once tubes go in or people are on ventilators, odds are grim. From FDA rulings to study designs to reports and media amplification, there is a consistent pattern of failing the stitch in time test. Or, if you will, we can put it in terms of Machiavelli's comparison of political disorders to hectic fever: at the first, easy to cure but hard to diagnose; when, at length, the disease is obvious to all, it is too late to cure. The good news, courtesy Jerry, is that there is some promise that Invermectin can extend the window of effective treatment. KF PS: And yes, I am pointing to something new that is beginning to climb the ladder of cumulative evidence, from in vitro to now early off label cases with a promising result. kairosfocus

kf - what do you mean by "stitch in time"? I'd expect that to allude to "a stitch in time saves nine", but in this study all of the patients were treated within 48 hours of diagnosis. TBH, I think that's pretty early. Do you instead mean that patients with milder symptoms are the ones that should be looked at? Bob O'H

BO'H: I suggest you will find it advisable to examine my point by point response to the abstract of the study reported in Lancet, in 199 just above. Further to this, I suggest that -- as pharmacology is the study of poisons in small doses -- range of dosages vs range of excessive toxicity may well depend on stage of disease and individual sensitivity. LD50 is after all, a reflection of variation. Yet further to this, the markup I made overnight is very compatible with results from elsewhere WHEN THEY ARE SET IN PROPER DISTINCT CONTEXT. One of the problems we have faced is comparison of sweet crab apples and unfortunately just as sweet -- at first -- manchineel death apples. KF PS: 199 shows why sometimes it is necessary to take some length to address a contentious matter. UD exists for that specific purpose of addressing issues of civilisational importance. kairosfocus

ET: Thanks for your reply @192, changing the shape of the receptor I get. In your statement @175 mentioned changing a vibration and it was that part that puzzled me. As we say in Ye Olde England: Keep Calm and Carry On. JVL

kf @ 195 - Thanks. I think all of our scroll wheels appreciate the shorter summary of your comment. Bob O'H

kf @ 178 -

BO’H: SE France is not particularly exceptional, save in the dominant narrative.

OK, thanks. So the fact that we have evidence from around the world that HCQ is harmful suggests it is also harmful in the south-east of France. If the only difference is the narrative, it suggests this different narrative is doing harm. Bob O'H

F/N: Let's clip and comment from the Lancet Report in 130: >>Background Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. >> -- what defines "conclusive[ness]"? (If that becomes a gateway for gold standard fallacies of hyperskeptical denial, it will improperly undermine cumulative and collectively adequate warrant) >>Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.>> -- If this becomes overly suspicious and fear driven, it can feed improper dismissal >>Methods We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide [-->Macrolides inhibit protein synthesis in bacteria by reversibly binding to the P site of the 50S unit of the ribosome . . . . macrolides include azithromycin ] for treatment of COVID-19.>> -- Part of the cocktail . . . >>The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. >> -- Jerry's point is clearly confirmed, the study effectively filtered out the key population, the stitch in time group, likely leading to biasing the result from the outset. -- This has been a consistent pattern with studies and designs, and has been embedded in FDA statements -- why is this divergence of framing joined to failure to note the difference so common? -- Ivermectin may, on Broward County results, repeat MAY, be a step to lengthen the window of success for the cocktail >>Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide),>> -- Notice, in-hospital, so beyond the stitch in time threshold unless ivermectin or the like is added, per recent news >> and patients who received none of these treatments formed the control group. >> -- notice, control group as BAU, vs treatment group beyond the stitch in time threshold >>Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded.>> -- For what it is worth, they could have cross tabulated those arms too. >> The main outcomes of interest were in-hospital mortality>> -- confirming the stitch in time forfeit. >> and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation).>> -- which may tie to the Covid 19 disease process -- was there filtering on that issue? >>Findings 96?032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14?888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide)>> -- the treatment groups are not far beyond the magnitude of the IHU groups. As a rule of thumb, fluctuations tend to go as sqrt n, so it is hard to reduce them without very large shifts in numbers - let me add, say fluctuations for n1 are c*sqrt(n1), so we see fraction c * sqrt n1:n, to halve this, we need some x k so that sqrt k: k is 1/2, x k is x 4. To reduce to 1/10 of original fraction we need sqrt k:4 is 1/10, i.e. x k becomes x 100, and so forth. Costs, typically, are disproportionate to increased scale. >> and 81?144 patients were in the control group.>> -- control on BAU, confirmed >> 10?698 (11·1%) patients died in hospital. >> -- confirms, these are seriously ill, hospitalised and beyond the stitch in time threshold >>After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity),>> -- but not, the stitch in time group that was not studied >> when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality.>> -- All beyond the stitch in time threshold >> Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.>> -- Again, beyond the stitch in time threshold. -- As at now, consideration should be made to see if Ivermectin should come into the cocktail and obviously, monitoring for heart toxicity or preconditions >>Interpretation We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. >> -- being, beyond the stitch in time threshold -- Raoult, Lozano, Zelenko + 60 etc are studying a different population and seek to avert hospital admission -- The dismissals of their work on this report are ill-founded, on the mangoes vs guavas principle. Crab apples are not manchineel death apples; the latter LOOK and apparently TASTE like the former (based on report of a yachting case here some years ago) but are potentially deadly >>Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.>> -- But the populations are not relevant. CONCLUSION: It seems that apples and death apples are not to be compared. Could the gap in populations/ point along the disease process identified explain the gap in reported outcomes, rendering the two sets of studies actually compatible in logic but not directly comparable in evaluating the real world effectiveness of HCQ cocktails? KF kairosfocus

PPS: Notice, discussion in the context of a patient, a Mr Reed:

Dr. Rajter said Reed fit the criteria he set for trying the new regimen. Reed was in bad shape, rapidly going downhill, but not yet ready to intubate. As Rajter explains it, once they’re intubated, the medication does not have as much impact. “I took those people who invariably were going to crash, meant they were going from room air to 50% oxygen in a matter of hours, I know where that’s headed,” Dr. Rajter said, pointing out that COVID-19 patients often deteriorate extremely fast. The FDA issued a warning today, saying while Ivermectin is approved for use in humans to fight parasites, more studies need to be done to prove its worth in fighting COVID19. Dr. Rajter agrees and so does Dr. Cepelowicz-Rajter, saying that’s exactly what they are doing. [--> through cases implicitly compared to business as usual] In fact, Dr. Rajter received approval late Monday afternoon from Broward Health to use his protocol in all of their hospitals. That means COVID-19 patients at Broward Health Medical Center, Broward Health North. Broward Health Imperial Point, and Broward Health Coral Springs might be receiving the Ivermectin cocktail, depending on their conditions.

Notice, Ivermectin had in vitro effect and was tried using off label, emergency and compassionate principles. If this holds up, we may be seeing how further increments to the cocktail just may stretch the window of effectiveness. The pessimism on once one goes on tubes [or a ventilator] should also be noted. kairosfocus

EG, did you note that my purpose in commenting as I did in was "that our thought space needs to open up"? That is why I was openly speculative. You will also find Jerry's remark at 196 perhaps helpful:

Why were they in the hospital? They were not outpatients. From what I understand they were far along in the virus and had serious symptoms. Tests were performed after they entered hospital. Which means they were late stage. The drug is to prevent hospitalization.

So, let us be open to all of the valid evidence, in interests of a sound inference to the best explanation. And, the question of equating control designs to placebo designs is clearly material to how "control" is being used. KF PS: I clip from Jerry's linked:

[Dr. Jean-Jacques Rajter] and his wife, who is also a pulmonologist, are pioneering the use of an anti-parasitic drug called Ivermectin to fight the novel coronavirus. “If we get to these people early, and what I mean by that is if their oxygen requirements are less than 50%, I’ve had nearly a 100% response rate, they all improve, if they’re on more oxygen than that, then it becomes a little more varied, some people, they don’t respond anymore because they are too far advanced,” explained Dr. Rajter. Two weeks ago, Dr. Rajter started adding Ivermectin to the cocktail of drugs currently used to treat COVID-19: hydroxychloraquine, azithromycin, and zinc sulfate. [--> shows where a lot of clinicians are] Since then he’s treated dozens of people with this combination, with results so encouraging, he calls them remarkable. Dr. Rajter is in the process of publishing a scientific paper, which could take weeks to publicize the findings. “But if I wait, every day that goes by is another day when lots and lots of people get very sick, go to ICU, many of them die and that could theoretically even be preventable and that’s why I thought it was so critically important to get this information out there,” Dr. Rajter said. He credits his wife, Dr. Juliana Cepelowicz-Rajter, with the idea of using Ivermectin for this purpose. She came across Australian research which showed Ivermectin destroys the virus in the lab, in vitro, but it has not been studied for this purpose in people. “More studies need to be conducted,” Dr. Cepelowicz-Rajter said. “We haven’t had any ill effects from it and it’s readily available, we have some patients who are pretty advanced, not yet intubated, and even those, in 12 hours, they showed a significant improvement.”

Notice, how he speaks:

It is not a cure. That’s the first thing Dr. Jean-Jacques Rajter wants everyone to know about the treatment he’s using on his COVID-19 patients at Broward Health Medical Center. “Ideally, the sooner you get to them, the better off they are,” said Dr. Rajter, a pulmonologist.

The key principle, clearly is, a stitch in time saves nine. kairosfocus

The lancet study only included patients who received treatment within 48 hrs of diagnosis, well within the timeframe that you claim it is effective

Why were they in the hospital? They were not outpatients. From what I understand they were far along in the virus and had serious symptoms. Tests were performed after they entered hospital. Which means they were late stage. The drug is to prevent hospitalization. Another doctor with success stories using HCQ plus. Adding Ivermectin to zinc and azithromycin https://www.nbcmiami.com/news/local/local-doctor-tries-new-coronavirus-drug-treatment/2219465/ jerry

EG, evasion again. KF kairosfocus

KF

EG, you are conflating control group with placebo control group.

The red herring must be shoaling off your little island. I am comparing two non-controlled retrospective studies, the one you keep shilling for like the My Pillow guy, and the much larger, more comprehensive, one published in the lancet. Why you keep bringing up the ethics of placebos is beyond me given that neither study involved these. The fact that you refuse to address the merits (or flaws) of the Lancet paper speaks volumes, and not in your favour. Have you even read it, or have you already decided that you are right and reading anything that might contradict your opinion would be a waste of time? Ed George

EG, you are conflating control group with placebo control group. I have pointed to the ethical issue of giving deliberately mislabelled sugar pills to those facing a fast acting, significantly fatal disease and the alternative that business as usual vs a credible, promising possibility is thus a more valid design in such cases, per do no harm. This is the issue discussed in the article you are still evading. As for the various oh see proof it does not work claims, there is first the pattern of in vitro/chemical action results, plausible mechanisms and known ability to go into tissue in effective concentrations. The relevant biochemistry would suggest at this point, at minimum, some promise, with also particular expectation of some anti-inflammatory action . . . common to even malaria action.Thus, in that context, the presence of a significant body of findings of success that align with that pattern has to be reckoned with seriously. This body includes reports of rapid clearing action by patients and by doctors. At the most, other studies need to be assessed as to why they diverge (apart from simply denigrating and dismissing what is tossed). And, you are far too well educated not to grasp these points. KF PS: Let me add a few thoughts. There is some discussion of a wide range of patterns of infection, from asymptomatic to mild to rapidly lethal and aggressive. Where, this is an RNA virus, suggestive of rapid mutations. In that context, could we be seeing early signs of fairly divergent strains and possible presence of some drug resistance? Suppose, effectiveness is fairly marginal, dependent on cumulative or even chained action of mechanisms. If resistance develops somewhat to one aspect that can break the margin. Where, if such is at work it may mean that vaccinations will be a challenge. Such is a speculation, obviously, but it is evident to me that our thought space needs to open up. kairosfocus

JVL- Hopeful: Summary of Wuhan #Coronavirus Therapies and Potential Cures:

The mechanism of chloroquine action on RA has long been well known. It increases a cell’s lysosomal pH. (Lysosomes are membrane bound cellular organelles [think tiny balloons inside the cell floating at a lower pH in the higher pH cytosol] containing about 50 enzymes, discovered and named in 1955.) This in turn changes their ‘leaked’ enzyme balance into the cytosol, which then inhibits the cell’s RA tissue antigen signaling, which in turn reduces the immune system’s attack on the RA tissue, slowing (but usually not stopping) progression of RA tissue damage. The reason the Chinese and then the French thought to use chloroquine against Wuhan coronavirus is this same mechanism of action, albeit with different sequelae. The viral S protein binds to the epithelial cell wall’s angiotensin-converting enzyme 2 (ACE2) receptor. Raising lysosomal pH changes (via indirect enzymatic action) the ‘shape’ of ACE2 enough that the S protein cannot bind to it, thus preventing cell infection. Chloroquine changes the cell ‘lock’ so the viral ‘key’ doesn’t work. Does not undo damage from infected cells, nor prevent an infected person from shedding existing viable virus, but does stop the spread in an infected person’s body—a promising therapeutic for those testing positive.

That's from March 20, 2020 ET

Jerry

The Lancet study is irrelevant to the issues being debated. It is an analysis of a time in the progression of the disease when HCQ will be less effective so any report of late stage use of HCQ is meaningless in the fighting of the virus. The issue is will administering of HCQ at early stages, within 12 days of initial infection affect the suppression of the virus.

The lancet study only included patients who received treatment within 48 hrs of diagnosis, well within the timeframe that you claim it is effective.

Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded.

Ed George

The public is already aware that established superspreaders of the virus can include “hospitals, nursing homes, large dormitories, food processing plants and food markets.

Could all be treated with HCQ and zinc? The cost is 47 cents a day per person.

As of Friday, COVID-19 had killed more than 95,000 people in the US in just four months.

Probably the great majority could have been saved if the medical community listened to Trump and Zelenko. Who is responsible for people not listening? Youtube takes down Zelenko videos in the name go community standards. They took down one of MedCram's videos on the effectiveness of zinc. (WHO the World Health Organization is also responsible for people not listening.) One lost of life or victim is a tragedy. Several thousands victims are just statistics or just dots from a distance. How many in our society are just like Harry Lime and only see dots. https://bit.ly/3aMWiC4 jerry

Eight countries have death rates higher than 10%: Belgium, France, Italy, Mexico, the Netherlands, Spain, Sweden, and the UK, according to a Johns Hopkins University database. Other places like Singapore, which has a robust testing program, have reported rates as low as 0.1%. A number of factors can drive death rates up. Sweden, for example, never issued a mandatory lockdown, instead asking its citizens to voluntarily maintain social distance. Experts warned early on that this strategy could lead to more death. The virus might also be reaching more elderly people there, who are more susceptible to severe illness. High death rates could also be the result of limited testing capacity. Countries with scarce testing resources tend to prioritize the most severe cases for COVID-19 confirmation, leaving many people with mild or asymptomatic cases undetected, thus giving the appearance of an unusually high death rate. Sweden has only just expanded its testing to include those with mild symptoms. As of Friday, COVID-19 had killed more than 95,000 people in the US in just four months. https://www.businessinsider.com/coronavirus-death-rates-high-deadlier-than-flu-2020-5 rhampton7

Some scientists now say “superspreader” events may be responsible for at least 80 percent of coronavirus infections. A report on the website of The Telegraph, a British newspaper, details some findings that “closely packed markets, vigorous dance classes, loud bars and choirs” may be the primary culprits in the spreading of the virus. The public is already aware that established superspreaders of the virus can include “hospitals, nursing homes, large dormitories, food processing plants and food markets.” https://www.voanews.com/covid-19-pandemic/superspreader-events-may-be-responsible-80-covid-infections rhampton7

The Lancet study is irrelevant to the issues being debated. It is an analysis of a time in the progression of the disease when HCQ will be less effective so any report of late stage use of HCQ is meaningless in the fighting of the virus. The issue is will administering of HCQ at early stages, within 12 days of initial infection affect the suppression of the virus. There is ample evidence that it does suppress the virus when administered early and almost no evidence that it is harmful. So studies like the one reported in Lancet are essentially fake news because they are irrelevant to the issue. The are late stage treatment studies. There is nothing wrong with trying to find a late stage treatment but using these studies to abrogate all uses of HCQ are fallacious. One has to wonder at why they are being used to do so. But for something relevant see https://bit.ly/3gj4mic

Background: Severe acute respiratory syndrome (SARS) is caused by a newly discovered coronavirus (SARS-CoV). No effective prophylactic or post-exposure therapy is currently available. Results: We report, however, that chloroquine has strong antiviral effects on SARS-CoV infection of primate cells. These inhibitory effects are observed when the cells are treated with the drug either before or after exposure to the virus, suggesting both prophylactic and therapeutic advantage. In addition to the well-known functions of chloroquine such as elevations of endosomal pH, the drug appears to interfere with terminal glycosylation of the cellular receptor, angiotensinconverting enzyme 2. This may negatively influence the virus-receptor binding and abrogate the infection, with further ramifications by the elevation of vesicular pH, resulting in the inhibition of infection and spread of SARS CoV at clinically admissible concentrations. Conclusion: Chloroquine is effective in preventing the spread of SARS CoV in cell culture. Favorable inhibition of virus spread was observed when the cells were either treated with chloroquine prior to or after SARS CoV infection. In addition, the indirect immunofluorescence assay described herein represents a simple and rapid method for screening SARS-CoV antiviral compounds

This is from 15 years ago. For the lighter side https://bit.ly/2AZbcJD jerry

Researchers will be testing whether Vitamin C and Zinc help reduce the likelihood of a newly diagnosed COVID-19 patient being hospitalized. Researchers also want to see if it can reduce the severity and duration of symptoms. “The goal is to start these medications within two days of your diagnosis,” McWilliams said. McWilliams said they will have a goal of enrolling 520 Cleveland Clinic patients in the trial within two days of their positive diagnosis. McWilliams said it is possible some of those trial participants could be patients on the Treasure Coast. “Vitamin C and Zinc have been around for a long time in the outpatient setting. There’s a lot of products out there. They’re all used for colds and flu,” McWilliams said. The soon-to-open Cleveland Clinic Florida Research and Innovations Center (FRIC) in Port St. Lucie, Florida, will be an essential part of research and treatment for COVID-19. https://www.wptv.com/news/coronavirus/cleveland-clinic-florida-spearheading-clinical-trials-to-test-success-of-vitamin-c-and-zinc-as-treatment-in-covid-19-patients rhampton7

We started this thinking if you had COVID and you came to the ICU and you got put on a ventilator it was a death sentence,” Emory’s Dr. Craig Coopersmith said. “We've become significantly more aggressive in trying to prevent blood clots and treat blood clots,” Piedmont's Dr. Amy Hajari Case added. Proning, or placing the patients on their bellies for a few hours instead of their back, has helped reduce the amount of time a ventilator is in use. They're discovering it may even keep some people off of them. “We're finding for COVID it appears to be effective before anyone gets put on a breathing machine,” Coopersmith said. From quirks in how COVID-19 responds to fluids and changes in ventilator settings, doctors say they're learning so fast because they're learning from each other. “I start the day somewhere between 7, 7:30 in the morning with a text that says, good morning team COVID,” Coopersmith said. “Mulitple ICU's - multiple doctors - who never literally had met each other before are now texting each other saying, ‘I've seen this. Have you seen this?’” “I think that's led to a very rapid understanding of maybe unanticipated elements of their care,” Case said. https://www.11alive.com/article/news/health/coronavirus/coronavirus-treatments-evolution-georgia/85-17f20a8e-92b6-4355-aea8-b120971dd825 rhampton7

KF

Non-controlled is of course the gold standard fallacy, and it is precisely why the clip you keep evading is highly relevant.

Please enlighten me. How is bringing up controlled studies relevant when all I am doing is comparing two non-controlled studies. Raising your misplaced ethical concerns about controlled studies is a rouge Clupea harengus.

A study of cases is evidence and this one compares the cocktail treatment with non treatment, through a major research centre in a significant hospital complex

And the paper I linked to is a study of cases comparing the cocktail treatment with HCQ treatment and non treatment in >96,000 patients from 671 hospitals on six continents. Ed George

RH7, HCQ is an old, generic, easily manufactured drug by today's standards. Any shortages that emerge will be quite temporary. The issue, further, is an emerging new market for it which would address a pandemic that is not only fast acting and fatal in many cases, but also one which has led to a global lockdown threatening to trigger deep recession or depression, which also have damaging and too often fatal consequences. Again, we see want of responsible balance in the sort of talking points that are used to shape the dominant narrative being pushed by various power interests. That sort of imbalance is always a sign that something is seriously wrong. KF kairosfocus

Lupus patients in the U.S. who rely on hydroxychloroquine are beginning to worry as the nation's supply of the drug dwindles in the midst of the coronavirus pandemic, calling the situation "survival of the fittest." According to USA Today, Jennifer McCollom, 48, of Thornton, Colo. has grappled with lupus for eight years, and couldn't get her medication for more than two weeks due to supply shortages of hydroxychloroquine. The Food and Drug Administration (FDA) added hydroxychloroquine to its list of drugs in shortage on March 31, following a surge of state and local governments stockpiling it throughout March. Data shared by Vizient, a group purchasing organization that serves nearly 3,000 medical facilities in the U.S., showed the demand for hydroxychloroquine surged almost 17 times higher in April compared to January. The report added that the available volume of the drug last month was only half of the total units ordered. "It shouldn't be hoarded away from people who are sick like us," said McCollum. "It feels to me like survival of the fittest right now." https://thehill.com/policy/healthcare/499293-as-nations-hydroxychloroquine-supply-runs-low-patients-who-rely-on-it-begin rhampton7

EG: >>a flawed>> -- projection: sez who, this indicates an attitude from the outset >> non-controlled retrospective study>> -- Non-controlled is of course the gold standard fallacy, and it is precisely why the clip you keep evading is highly relevant -- A study of cases is evidence and this one compares the cocktail treatment with non treatment, through a major research centre in a significant hospital complex -- the results are consistent with the known ability of HCQ et al to enter and spread across the body, its known impact on the virus [and others] in plausible in-tissue concentrations, the existence of several plausible mechanisms and more. -- it is also compatible with significant report of rapid effect from physicians and patients, so we see a growing body of mutually consistent evidence coming from reasonable custody >> to a much larger (orders of magnitude)>> -- beyond law of large numbers scale mere size is not all >> well designed, more comprehensive,>> -- sez who? -- recall, there is a pattern of converging lines of evidence to be addressed. >> non-controlled, retrospective study>> -- same basic issue. KF PS: Touting is a fighting word, drop it. Maybe the issue of converging lines of evidence does not impress you, it should. And clearly you disregard the ethical challenges faced by placebo based study designs. That's another reason to see just why what you evade is relevant. kairosfocus

KF

EG, it seems we need yet another round of counsel from the Kennedy School that you have ducked since comment 56, noting that one half is a professor there, the other is a French PhD graduate from it. KF

I have no idea why you keep repeating this as it has no relevance when comparing a flawed non-controlled retrospective study to a much larger (orders of magnitude) well designed, more comprehensive, non-controlled, retrospective study. Given current information, your continued touting of HCQ for COVID-19 simply is not warranted. Ed George

EG, it seems we need yet another round of counsel from the Kennedy School that you have ducked since comment 56, noting that one half is a professor there, the other is a French PhD graduate from it. KF PS: Duly,

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory.

kairosfocus

BO'H: SE France is not particularly exceptional, save in the dominant narrative. I add, I suggest you listen to what Dr Lozano has to say. She is by no means an isolated individual. KF kairosfocus

KF

EG, what part of, Placebo controlled studies will take far too long in the teeth of a fast moving pandemic is so hard to understand?

What part of, accepting the greatly flawed conclusions of a non-controlled retrospective study while ignoring a far larger, more comprehensive, better designed retrospective study don’t you understand? Ed George

ET: This change may affect the vibration of the ACE2. When that happens covid-19 cannot bind to it. I've been trying to track down this idea, references? JVL

Again, HCQ alone just changes the Ph of the body. This change may affect the vibration of the ACE2. When that happens covid-19 cannot bind to it. HCQ with zinc puts more zinc into cells. This added zinc can then prevent the virus from replicating. The science is well known. So I don't understand why the evos here have against science ET

kf @ 169 - so why is the south-east of France different to the rest of the world? And why are you ignoring results from the rest of the world? Especially as you've repeatedly linked to an essay arguing for precisely the sorts of studies that have been done (and NOT the sorts of studies Raoult is doing)? Bob O'H

PS: I note, the tier 2 approval is good enough more or less, releasing to physician-patient judgement. The issue now shifts to narrative dominance and implications of what we collectively create as dominating message. kairosfocus

JVL, in the face of pandemic, time is precisely what we do not have. KF kairosfocus

Kairosfocus: A far better answer is, there is a reason why FDA, within a day or two of Raoult’s tier 2 results on chemical action and effectiveness, with 80 patients, moved up the emergency off label approval. And after significant professional protest on the ferocious warnings on toxicity, it is far more plausible that they felt it wisest to revert to the balance in the second tier statement. Maybe. Hopefully time will tell, someday. JVL

JVL, the projection is telling. It is obvious that Mr Trump is a minority voice and the NIH/FDA people have made no bones to say things that cut across his discussion or at least moderate it. With talk of a second impeachment attempt on the table, that suggestion is utterly unlikely. A far better answer is, there is a reason why FDA, within a day or two of Raoult's tier 2 results on chemical action and effectiveness, with 80 patients, moved up the emergency off label approval. And after significant professional protest on the ferocious warnings on toxicity, it is far more plausible that they felt it wisest to revert to the balance in the second tier statement. KF PS: As there is no need, I am not on the cocktail, I have experimented with filter-level for cloth face masks towards sustainability. My initial conclusion is that a thin filter layer of meltblown felted fabric is less fatiguing than the thicker ~ 2 mm material (unless there is a breathe-out valve) in a filter pocket in a cotton fabric mask. I have concerns on rebreathing palpably warm air in the mask, indicating elevated CO2 levels and the sense of forcing to breathe. Where no, breathing in through nose and out and down through the lips does not work with close fitting masks. It might, with a bandana or the like. Some varieties of wet wipes are likely good enough for light duty use. Regular washing and sanitising of such masks is essential. kairosfocus

BO'H: kindly scroll up to the results excerpted in the OP, as of several days ago. One would expect on the BAU track a much higher death rate from IHU's treatments. The framework of cumulative evidence noted to RT suggests that we have in fact got an effective treatment and reports from too many sources and cases indicate far stronger, faster effects than one would pick up from the sort of things that are being headlined. My inference is, likely, breaking synergy and/or failing the stitch in time test. I particularly recall on this the Guardian report on a huge, placebo control test proposed for the UK. Where, as soon as I see placebo controls as gold standard without serious discussion of ethical issues, for cause my concern level goes up. Political polarisation is toxic and arguably dangerous. KF kairosfocus

Kairosfocus: Ask yourself, why are they backing away? Political pressure I'd guess 'cause normally they'd stick to a strict RCT policy of approval. JVL

JVL, see my just now to RT on why I take the media and officialdom crescendo less than at face value. A common pattern is breaking the synergy and/or failing the stitch in time test. In the case of Mr Trump, he has insisted on off label use on the FDA second level emergency use approval (which is of course not part of the dominant narrative). I suspect he is on various supplements and multivitamins so C and D are already there, he just added HCQ, Azithro and Zn. This, in a context of the FDA backing away from the ferocious warnings it gave some weeks back: >>The U.S. Food and Drug Administration said Tuesday that taking hydroxychloroquine is "ultimately" a choice between patients and their health-care providers, appearing to soften its earlier advisory against taking the anti-malaria drug outside of a hospital.>> Ask yourself, why are they backing away? KF kairosfocus

BA77, yes, there are interconnexions in how we address inductive warrant and conclusions. KF kairosfocus

RT, actually, the routine media construction of dominant but tendentious ideologically loaded, manipulative and too often deceitful and dangerous narratives that is a key part of the situation. We have to counter that bias and seek alternatives. In this case, between the gold standard fallacy, selectively hyperskeptical suppression of evidence, the ongoing 4th gen civil war in the US and a raging pandemic, we are racking up terrible, needless body counts. For, on Raoult's evidence alone [and it is not alone!] we could have reduced the death rates globally by up to 80 - 90+ percent. If, we were in a different world. We need to face where business as usual [BAU] through the balance of faction power games is taking us and seek a credible alternative [ALT]. To do so, we have to change the rules of the game and break the unjustified, power-driven lockouts through promoting participation of the hitherto marginalised, stereotyped and scapegoated. We need thinking spaces (such as UD) and media spaces for more genuinely broad based public participation. Then, gap analysis and linked SWOT-scenario planning can help us shape more robust solutions. (All of this BTW, I have pushed for for twenty years.) And yes, that is sustainability oriented decision theory in action at policy choice level. Now, you are asking good questions about why the role of Zn is not being explained to the public. Sadly, that's because it fits in with one of the plausible modes of action of HCQ: ionophore lock-open allowing Zn to diffuse into the cell in higher than normal concentrations. Which then stops the virus replication cycle. In another plausible mode of action, pH shifts through HCQ affect local fields so shifting vibrational frequencies of receptors targeted by the SARS2 virus. A third mode is routinely used in the treatment of arthritis and lupus: anti-inflammatory action, which Chinese Doctors saw as a first reason to use it. Azithromycin also has both anti secondary infection effects and some antiviral properties. Vitamins C and D of course are good for infections. Cumulative effects count. Where, too, with in vitro effects on the record since 2005 and recently reconfirmed by Raoult et al at plausible cell level concentrations, plausible models and BAU vs ALT differences in not only death rates but consistent reports of felt relief in 5 to 48 hours, and viral clearance in 5 - 6 days, the picture on plausibility would have shifted. Likewise, if Raoult and his IHU with 80+ staff and a peer-reviewed publication "factory" operating in a 3500 or so bed four hospital cluster in Marseilles were fairly reported, the plausibility balance would also shift. So, we can now deconstruct the game, using the plausibility structure, dominant narrative, silencing of the marginalised pattern. A game that is clearly adversely affecting policy and in so doing has credibly cost lives. Then, there is that dismal calculus issue of minimising lives lost through pandemic and lockdown-triggered economic, social and psychological crisis. Deaths of despair is a serious, sobering issue globally and famine is on the table once economic crisis enters stage left, as one of the four infamous horsemen. We need to think again. KF kairosfocus

Of note to KF, sorry for taking up so much space on your thread, but I thought it was important to expose Darwinists for the scientific frauds that they are, since their false claims could, in this case, potentially, kill some people. And again. I hold that we give Bob the disease in its most virulent form and, for the sake of science, see if he will then choose the HCQ cocktail when he himself faces his own mortality. There is nothing like the real world consequences in their own lives, the consequences of their own thoughts' potential impact on other people lives, to bring the point home to those who live in ivory towers high above all those sme!ly Walmart shoppers. bornagain77

Darwinists, with their vital dependence on faulty theological presuppositions, instead of on any actual scientific evidence, in order to try to make their case for Darwinian evolution are, as Cornelius Van Til put it, like the child who must climb up onto his father’s lap into order to slap his face.

“In other words, the non-Christian needs the truth of the Christian religion in order to attack it. As a child needs to sit on the lap of its father in order to slap the father’s face, so the unbeliever, as a creature, needs God the Creator and providential controller of the universe in order to oppose this God. Without this God, the place on which he stands does not exist. He cannot stand in a vacuum.” - Cornelius Van Til, Essays on Christian Education (The Presbyterian and Reformed Publishing Company: Phillipsburg, NJ, 1979).

As should be needless to say, if the theory you champion as being science forsakes repeated experimentation and champions faulty theology, then your theory cannot possibly be a 'science' in any meaningful definition of the term 'science', but your supposed scientific theory must instead be a pseudoscience, even a false religion masquerading as science, rather than being a true 'science' Moreover, although Darwinists here on UD and elsewhere are fond of claiming that Intelligent Design is a pseudoscience, even a religion instead of a science, the fact of the matter is that all of science, every nook and cranny of it, is based on intelligent design and is certainly not based on methodological naturalism as is presupposed by Darwinists. From the essential Christian presuppositions that undergird the founding of modern science, i.e. that the universe is rational and that the minds of men, being made in the ‘image of God’, can dare understand that rationality, to the intelligent design of the scientific instruments and experiments themselves, to the logical and mathematical analysis of experimental results, from top to bottom science itself is certainly not ‘natural’. Not one scientific instrument would ever exist if men did not first intelligently design that scientific instrument. Not one test tube, microscope, telescope, spectroscope, or etc.. etc.., was ever just found laying around on a beach somewhere which was ‘naturally’ constructed by nature. Not one experimental result would ever be rationally analysed since there would be no immaterial minds to rationally analyze the immaterial mathematics that lay behind the intelligently designed experiments in the first place. As to essential nature of the immaterial, i.e. 'abstract', realm to science. Darwinists ultimately seek to ‘scientifically’ explain everything in materialistic terms. i.e. Reductive materialism. And yet, if something is not composed of particles or does not have physical properties (e.g., length, mass, energy, momentum, orientation, position, etc), it is abstract, even ‘spiritual’. Numbers, mathematics, logic, truth, distance, time, beauty, ugliness, species, person, information, science, etc.. etc.. all fall into that category of being an abstract property of the immaterial mind. It is amazing how many things fall into that ‘abstract’ category even though most everyone, including atheists, (“atheists” also happens to be an abstract term itself), swear that they exist physically. Perhaps the most devastating place that the denial of the abstract realm is for Darwinists, scientifically speaking, is with their denial of the reality of the immaterial, i.e. abstract, realm of mathematics.

What Does It Mean to Say That Science & Religion Conflict? – M. Anthony Mills – April 16, 2018 Excerpt: Barr rightly observes that scientific atheists often unwittingly assume not just metaphysical naturalism but an even more controversial philosophical position: reductive materialism, which says all that exists is or is reducible to the material constituents postulated by our most fundamental physical theories. As Barr points out, this implies not only that God does not exist — because God is not material — but that you do not exist. For you are not a material constituent postulated by any of our most fundamental physical theories; at best, you are an aggregate of those constituents, arranged in a particular way. Not just you, but tables, chairs, countries, countrymen, symphonies, jokes, legal contracts, moral judgments, and acts of courage or cowardice — all of these must be fully explicable in terms of those more fundamental, material constituents. In fact, more problematic for the materialist than the non-existence of persons is the existence of mathematics. Why? Although a committed materialist might be perfectly willing to accept that you do not really exist, he will have a harder time accepting that numbers do not exist. The trouble is that numbers — along with other mathematical entities such as classes, sets, and functions — are indispensable for modern science. And yet — here’s the rub — these “abstract objects” are not material. Thus, one cannot take science as the only sure guide to reality and at the same time discount disbelief in all immaterial realities. https://www.realclearreligion.org/articles/2018/04/16/what_does_it_mean_to_say_that_science_and_religion_conflict.html

Mathematics is considered the backbone of all science, engineering, and technology, and yet, in irony of irony, the reductive materialism that undergirds Darwinian evolution denies the very reality of the one thing, i.e. mathematics, that it most needs in order to be considered scientific in the first place. In fact, besides mathematics, the term ‘science’ itself is an abstract term that cannot possibly be grounded within the reductive materialistic framework that provides the foundation for Darwinian evolution! Thus, not only is Darwinian evolution NOT science, it actually denies the physical reality of science. :) Even the term 'species' itself is an abstract term and/or definition of the immaterial mind that cannot be reduced to any possible materialistic explanation. In the reductive materialism that undergirds Darwinian evolution, there is simply no way to tell one species from another species, much less is there a way to demarcate humans from non-humans:

Darwin, Design & Thomas Aquinas – Logan Paul Gage Excerpt: The Essences of Species First, the problem of essences. G. K. Chesterton once quipped that “evolution . . . does not especially deny the existence of God; what it does deny is the existence of man.” It might appear shocking, but in this one remark the ever-perspicacious Chesterton summarized a serious conflict between classical Christian philosophy and Darwinism. In Aristotelian and Thomistic thought, each particular organism belongs to a certain universal class of things. Each individual shares a particular nature—or essence—and acts according to its nature. Squirrels act squirrelly and cats catty. We know with certainty that a squirrel is a squirrel because a crucial feature of human reason is its ability to abstract the universal nature from our sense experience of particular organisms. Denial of True Species Enter Darwinism. Recall that Darwin sought to explain the origin of “species.” Yet as he pondered his theory, he realized that it destroyed species as a reality altogether. For Darwinism suggests that any matter can potentially morph into any other arrangement of matter without the aid of an organizing principle. He thought cells were like simple blobs of Jell-O, easily re-arrangeable. For Darwin, there is no immaterial, immutable form. In The Origin of Species he writes: “I look at the term species as one arbitrarily given, for the sake of convenience, to a set of individuals closely resembling each other, and that it does not essentially differ from the term variety, which is given to less distinct and more fluctuating forms. The term variety, again, in comparison with mere individual differences, is also applied arbitrarily, for convenience’s sake.” Statements like this should make card-carrying Thomists shudder.,,, The first conflict between Darwinism and Thomism, then, is the denial of true species or essences. For the Thomist, this denial is a grave error, because the essence of the individual (the species in the Aristotelian sense) is the true object of our knowledge. As philosopher Benjamin Wiker observes in Moral Darwinism, Darwin reduced species to “mere epiphenomena of matter in motion.” What we call a “dog,” in other words, is really just an arbitrary snapshot of the way things look at present. If we take the Darwinian view, Wiker suggests, there is no species “dog” but only a collection of individuals, connected in a long chain of changing shapes, which happen to resemble each other today but will not tomorrow. What About Man? Now we see Chesterton’s point. Man, the universal, does not really exist. According to the late Stanley Jaki, Chesterton detested Darwinism because “it abolishes forms and all that goes with them, including that deepest kind of ontological form which is the immortal human soul.” And if one does not believe in universals, there can be, by extension, no human nature—only a collection of somewhat similar individuals.,,, https://www.touchstonemag.com/archives/article.php?id=23-06-037-f

You don’t have to take my word for it, last year a Darwinist admitted that “The most important concept in all of biology, (i.e. species), is a complete mystery”

What is a species? The most important concept in all of biology is a complete mystery – July 16, 2019 Excerpt: Enough of species? This is only the tip of a deep and confusing iceberg. There is absolutely no agreement among biologists about how we should understand the species. One 2006 article on the subject listed 26 separate definitions of species, all with their advocates and detractors. Even this list is incomplete. The mystery surrounding species is well-known in biology, and commonly referred to as “the species problem”. Frustration with the idea of a species goes back at least as far as Darwin.,,, some contemporary biologists and philosophers of biology have,,, suggested that biology would be much better off if it didn’t think about life in terms of species at all.,,, https://theconversation.com/what-is-a-species-the-most-important-concept-in-all-of-biology-is-a-complete-mystery-119200

As should be needless to say, the inability for a supposedly scientific theory, a supposedly scientific theory that seeks to explain the “Origin of Species” in the first place, to be able to clearly define what a species actually is, is a clear indication that that supposedly scientific theory cannot possibly be the proper ‘scientific’ explanation for the “Origin of Species” in the first place. The reason why Darwinists will forever be stymied in their efforts to provide any rigid definition for the term ‘species’ actually is because the term species is an abstract property and/or definition of the immaterial mind that cannot possibly be reduced to any possible materialistic explanations. i.e. How much does the concept of species weigh? Does the concept ‘species’ weigh more in English or in Chinese? How long is the concept of species in millimeters? How fast does the concept go? Is the concept of species faster or slower than the speed of light? Is the concept of species positively or negatively charged? Or etc.. etc..?.. Besides the denial of the reality of the entire concept of species, Darwinists also deny, because they are also immaterial concepts, the reality of many other things that everyone, especially including Darwinists, resolutely hold to as being real and concrete, even though they are, in fact, immaterial concepts of the immaterial mind.

Basically, because of reductive materialism (and/or methodological naturalism), the atheistic materialist is forced to claim that he is merely a ‘neuronal illusion’ (Coyne, Dennett, etc..), who has the illusion of free will (Harris), who has unreliable, (i.e. illusory), beliefs about reality (Plantinga), who has illusory perceptions of reality (Hoffman), who, since he has no real time empirical evidence substantiating his grandiose claims, must make up illusory “just so stories” with the illusory, and impotent, ‘designer substitute’ of natural selection (Behe, Gould, Sternberg), so as to ‘explain away’ the appearance (i.e. illusion) of design (Crick, Dawkins), and who must make up illusory meanings and purposes for his life since the reality of the nihilism inherent in his atheistic worldview is too much for him to bear (Weikart), and who must also hold morality to be subjective and illusory since he has rejected God (Craig, Kreeft). Who, since beauty cannot be grounded within his materialistic worldview, must hold beauty itself to be illusory (Darwin). Bottom line, nothing is truly real in the atheist’s worldview, least of all, beauty, morality, meaning and purposes for life.,,, Darwinian Materialism and/or Methodological Naturalism vs. Reality – video https://www.youtube.com/watch?v=CaksmYceRXM

Thus, although the Darwinian Atheist firmly believes he is on the terra firma of science (in his appeal, even demand, for methodological naturalism), the fact of the matter is that, when examining the details of his materialistic/naturalistic worldview, it is found that Darwinists/Atheists are adrift in an ocean of fantasy and imagination with no discernible anchor for reality to grab on to. It would be hard to fathom a worldview more antagonistic to modern science, indeed more antagonistic to reality itself, than Atheistic materialism and/or methodological naturalism have turned out to be.

2 Corinthians 10:5 Casting down imaginations, and every high thing that exalteth itself against the knowledge of God, and bringing into captivity every thought to the obedience of Christ;

bornagain77

KF in 155 has, as usual for KF, done an excellent job of summarizing the strong evidence in favor using the HCQ cocktail as a effective therapeutic, early in treatments, for the disease, and also of noting the deficiencies in the studies that seek to dismiss the HCQ cocktail's effectiveness. But what strikes me most about the people on UD who have been, for weeks now, and who are currently, eager to dismiss the effectiveness of the HCQ cocktail as a therapeutic, and to thus potentially negatively impact people who are tying to recover from the disease, is that all these HCQ skeptics on UD are Darwinists. That is to say that they promote Darwinian evolution as somehow being unquestionably scientifically true. Many times saying that Darwinian evolution is scientific and also dismissing Intelligent Design as somehow being unscientific, some even going so far as to claim that Intelligent Design is a pseudoscience. Despite oft repeated claims to the contrary, the 'pseudoscientific' shoe is squarely on the other foot. I hold that if someone is going to argue that their opinions on scientific matters should be taken seriously, (as is the current argument with the HCQ cocktail), it might first greatly behoove them to first demonstrate the capacity to differentiate real science from pseudoscience in the first place with the ID vs Darwinism debate. In their general claim that Darwinian evolution is unquestionbly science and Intelligent Design is just a pseudoscience, I hold that these Darwinists on UD have forsaken any right to their claim that their present opinions on the HCQ cocktail in particular should be trusted. By any reasonable standard that one might use to judge whether a theory is even scientific of not, Darwinian evolution simply utterly fails to meet those criteria for being a science.

“There are five standard tests for a scientific hypothesis. Has anyone observed the phenomenon — in this case, Evolution — as it occurred and recorded it? Could other scientists replicate it? Could any of them come up with a set of facts that, if true, would contradict the theory (Karl Popper’s “falsifiability” tests)? Could scientists make predictions based on it? Did it illuminate hitherto unknown or baffling areas of science? In the case of Evolution… well… no… no… no… no… and no.” – Tom Wolfe – The Kingdom of Speech – page 17 Darwinian Evolution Fails the Five Standard Tests of a Scientific Hypothesis - video https://www.youtube.com/watch?v=L7f_fyoPybw

Darwin himself honestly admitted that his theory was unscientific.,, i.e. “I am quite conscious that my speculations run quite beyond the bounds of true science.” and “What you hint at generally is very, very true: that my work is grievously hypothetical, and large parts are by no means worthy of being called induction.”

Anti-Science Irony Excerpt: In response to a letter from Asa Gray, professor of biology at Harvard University, Darwin declared: “I am quite conscious that my speculations run quite beyond the bounds of true science.” When questioned further by Gray, Darwin confirmed Gray’s suspicions: “What you hint at generally is very, very true: that my work is grievously hypothetical, and large parts are by no means worthy of being called induction.” Darwin had turned against the use of scientific principles in developing his theory of evolution. http://www.darwinthenandnow.com/2011/10/anti-science-irony/

When Charles Darwin honestly admitted that "large parts (of my theory) are by no means worthy of being called induction”, Darwin was honestly admitting that he had forsaken the criteria of repeated experimentation that was set forth by Francis Bacon when he founded the scientific method,

Welcome To The Brave New World Of “Science” – Emily Morales – January 1, 2020 Excerpt: Darwin, in his day was excoriated by Adam Sedgewick (his mentor of the past) for abandoning the tram-road of inductive thinking (Baconian methodology, repeated experimentation) in favor of embracing the methodologies associated with deductive reasoning carried out by the likes of Aristotle. Sedgewick was not alone in his criticism of Darwin. Louis Agassiz, at Harvard similarly rebuked Darwin for a thesis having no support in the known fossil record (refer to Stephen Meyer’s book Darwin’s Doubt). Note that neither of these men pushed back against Darwin because they were creationists – it was rather that Darwin drew some conclusions on the diversity of life and origin of species that were presumptuous to say the least. As it turns out, Bacon addressed the dangers of this manner of “logic” and “reasoning,” at length, warning us of its ability to stifle scientific inquiry two hundred and thirty years before Darwin’s published work. Bacon today, would not be impressed with where the brave new world of science is heading. Rather than holding on to those facts that are the fruit of repeated experimentation or steadied observation, society is clinging to fallacies that are oftentimes the fruit of a past college professor’s wild imagination. https://uncommondesc.wpengine.com/intelligent-design/welcome-to-the-brave-new-world-of-science/#comment-690388

There is simply no experimental evidence, (nor mathematics), to be found in Darwin's book 'Origin of Species'.

Someone tries telling the truth: Darwin wasn’t that great but he met an elite need – July 29, 2014 Excerpt: he (Charles Darwin) devoted almost every bit of his magnum opus (Origin Of Species) to tedious examples of artificial selection in domestic animals. He brushed away the glaring advantage of artificial over natural selection with rhetoric along the lines of “I see no reason why” natural selection might not have fashioned the eye or any other organ or living thing. For such schoolboy ineptitude he was roundly criticized by his contemporaries, all of whom are now consigned to history’s dustbin, regardless of their skills and biological competency. https://uncommondesc.wpengine.com/intelligent-design/someone-tries-telling-the-truth-darwin-wasnt-that-great-but-he-met-an-elite-need/

To this day, over a century and a half later, there simply is no experimental evidence that Darwinists can appeal to so as to establish the validity of Darwinian evolution as a proper experimental science.

Scant search for the Maker - 2001 Excerpt: But where is the experimental evidence? None exists in the literature claiming that one species has been shown to evolve into another. Bacteria, the simplest form of independent life, are ideal for this kind of study, with generation times of 20 to 30 minutes, and populations achieved after 18 hours. But throughout 150 years of the science of bacteriology, there is no evidence that one species of bacteria has changed into another, in spite of the fact that populations have been exposed to potent chemical and physical mutagens and that, uniquely, bacteria possess extrachromosomal, transmissible plasmids. Since there is no evidence for species changes between the simplest forms of unicellular life, it is not surprising that there is no evidence for evolution from prokaryotic to eukaryotic cells, let alone throughout the whole array of higher multicellular organisms. - Alan H. Linton - emeritus professor of bacteriology, University of Bristol. http://www.timeshighereducation.co.uk/story.asp?storycode=159282 Darwin vs. Microbes (Where’s the substantiating evidence for Darwinian evolution?) - video https://youtu.be/ntxc4X9Zt-I

In fact, besides having no actual experimental evidence to substantiate their claims, Darwinists will often completely ignore evidence that directly falsifies their claims. Here are a few falsifications of Darwinian evolution that Darwinists simply refuse to ever accept as falsifications of their theory:

Darwin’s theory holds mutations to the genome to be random. The vast majority of mutations to the genome are not random but are now found to be ‘directed’. Darwin’s theory holds that Natural Selection is the ‘designer substitute’ that produces the ‘appearance’ and/or illusion of design. Natural Selection, especially for multicellular organisms, is found to grossly inadequate as the ‘designer substitute. Darwin’s theory holds that mutations to DNA will eventually change the basic biological form of any given species into a new form of a brand new species. Yet, biological form is found to be irreducible to mutations to DNA, nor is biological form reducible to any other material particulars in biology one may wish to invoke. Darwin’s theory holds there to be an extremely beneficial and flexible mutation rate for DNA which was ultimately responsible for all the diversity and complexity of life we see on earth. The mutation rate to DNA is overwhelmingly detrimental. Detrimental to such a point that it is seriously questioned whether there are any truly beneficial, information building, mutations whatsoever. Charles Darwin himself held that the gradual unfolding of life would (someday) be self-evident in the fossil record. Yet, from the Cambrian Explosion onward, the fossil record is consistently characterized by the sudden appearance of a group/kind in the fossil record(disparity), then rapid diversity within the group/kind, and then long term stability and even deterioration of variety within the overall group/kind, and within the specific species of the kind, over long periods of time. Of the few dozen or so fossils claimed as transitional, not one is uncontested as a true example of transition between major animal forms out of millions of collected fossils. Moreover, Fossils are found in the “wrong place” all the time (either too early, or too late). Darwin’s theory, due to the randomness postulate, holds that patterns will not repeat themselves in supposedly widely divergent species. Yet thousands of instances of what is ironically called ‘convergent evolution’, on both the morphological and genetic level, falsifies the Darwinian belief that patterns will not repeat themselves in widely divergent species. Charles Darwin himself stated that “If it could be demonstrated that any complex organ existed which could not possibly have been formed by numerous, successive, slight modifications, my theory would absolutely break down.” Yet as Doug Axe pointed out, “Basically every gene and every new protein fold, there is nothing of significance that we can show that can be had in that gradualistic way. It’s all a mirage. None of it happens that way.” Charles Darwin himself stated that “If it could be proved that any part of the structure of any one species had been formed for the exclusive good of another species, it would annihilate my theory, for such could not have been produced through natural selection.” Yet as Wolf-Ekkehard Lönnig pointed out, “in thousands of plant species often entirely new organs have been formed for the exclusive good of more than 132,930 other species, these ‘ugly facts’ have annihilated Darwin’s theory as well as modern versions of it.” Charles Darwin himself stated that, ““The impossibility of conceiving that this grand and wondrous universe, with our conscious selves, arose through chance, seems to me the chief argument for the existence of God. Yet ‘our conscious selves’ are certainly not explainable by ‘chance’ (nor is consciousness explainable by any possible reductive materialistic explanation in general), i.e. ‘the hard problem of consciousness’. Besides the mathematics of probability consistently showing that Darwinian evolution is impossible, the mathematics of population genetics itself has now shown Darwinian evolution to be impossible. Moreover, ‘immaterial’ mathematics itself, which undergirds all of science, engineering and technology, is held by most mathematicians to exist in some timeless, unchanging, immaterial, Platonic realm. Yet, the reductive materialism that Darwinian theory is based upon denies the existence of the immaterial realm that mathematics exists in. i.e. Darwinian evolution actually denies the objective reality of the one thing, i.e. mathematics, that it most needs in order to be considered scientific in the first place! Donald Hoffman has, via population genetics, shown that if Darwin’s materialistic theory were true then all our observations of reality would be illusory. Yet the scientific method itself is based on reliable observation. Moreover, Quantum Mechanics itself has now shown that conscious observation must come before material reality, i.e. falsification of ‘realism’ proves that our conscious observations are reliable!. The reductive materialism that undergirds Darwinian thought holds that immaterial information is merely ’emergent’ from a material basis. Yet immaterial Information, via experimental realization of the “Maxwell’s Demon” thought experiment, is now found to be its own distinctive physical entity that, although it can interact in a ‘top down’ manner with matter and energy, is separate from matter and energy. Darwinists hold that Darwin’s theory is true. Yet ‘Truth’ itself is an abstract property of an immaterial mind that is irreducible to the reductive materialistic explanations of Darwinian evolution. i.e. Assuming reductive materialism and/or Naturalism as the starting philosophical position of science actually precludes ‘the truth’ from ever being reached by science! Darwinists, due to their underlying naturalistic philosophy, insist that teleology (i.e. goal directed purpose) does not exist. Yet it is impossible for Biologists to do biological research without constantly invoking words that directly imply teleology. i.e. The very words that Biologists themselves use when they are doing their research falsifies Darwinian evolution.

Verse:

1 Thessalonians 5:21 Test all things; hold fast what is good.

In fact Charles Darwin, in his book ‘Origin”, instead of any actual experimentation or mathematics, (in fact Darwin said that he found mathematics to be ‘repugnant’), Darwin instead relied mainly on flawed theological argumentation in order to try to make his case for evolution

Charles Darwin, Theologian: Major New Article on Darwin’s Use of Theology in the Origin of Species – May 2011 Excerpt: The Origin supplies abundant evidence of theology in action; as Dilley observes: I have argued that, in the first edition of the Origin, Darwin drew upon at least the following positiva theological claims in his case for descent with modification (and against special creation): 1. Human beings are not justified in believing that God creates in ways analogous to the intellectual powers of the human mind. 2. A God who is free to create as He wishes would create new biological limbs de novo rather than from a common pattern. 3. A respectable deity would create biological structures in accord with a human conception of the ‘simplest mode’ to accomplish the functions of these structures. 4. God would only create the minimum structure required for a given part’s function. 5. God does not provide false empirical information about the origins of organisms. 6. God impressed the laws of nature on matter. 7. God directly created the first ‘primordial’ life. 8. God did not perform miracles within organic history subsequent to the creation of the first life. 9. A ‘distant’ God is not morally culpable for natural pain and suffering. 10. The God of special creation, who allegedly performed miracles in organic history, is not plausible given the presence of natural pain and suffering. http://www.evolutionnews.org/2011/05/charles_darwin_theologian_majo046391.html

To this day, instead of any actual experimentation to try to make their case, Darwinists are still heavily reliant on flawed theological argumentation in order to try to make their case for Darwinian evolution.

Methodological Naturalism: A Rule That No One Needs or Obeys - Paul Nelson - September 22, 2014 Excerpt: It is a little-remarked but nonetheless deeply significant irony that evolutionary biology is the most theologically entangled science going. Open a book like Jerry Coyne's Why Evolution is True (2009) or John Avise's Inside the Human Genome (2010), and the theology leaps off the page. A wise creator, say Coyne, Avise, and many other evolutionary biologists, would not have made this or that structure; therefore, the structure evolved by undirected processes. Coyne and Avise, like many other evolutionary theorists going back to Darwin himself, make numerous "God-wouldn't-have-done-it-that-way" arguments, thus predicating their arguments for the creative power of natural selection and random mutation on implicit theological assumptions about the character of God and what such an agent (if He existed) would or would not be likely to do.,,, ,,,with respect to one of the most famous texts in 20th-century biology, Theodosius Dobzhansky's essay "Nothing in biology makes sense except in the light of evolution" (1973). Although its title is widely cited as an aphorism, the text of Dobzhansky's essay is rarely read. It is, in fact, a theological treatise. As Dilley (2013, p. 774) observes: "Strikingly, all seven of Dobzhansky's arguments hinge upon claims about God's nature, actions, purposes, or duties. In fact, without God-talk, the geneticist's arguments for evolution are logically invalid. In short, theology is essential to Dobzhansky's arguments.",, - per evolution news Damned if You Do and Damned if You Don't - Steve Dilley- 2019-06-02 The Problem of God-talk in Biology Textbooks Abstract: We argue that a number of biology (and evolution) textbooks face a crippling dilemma. On the one hand, significant difficulties arise if textbooks include theological claims in their case for evolution. (Such claims include, for example, ‘God would never design a suboptimal panda’s thumb, but an imperfect structure is just what we’d expect on natural selection.’) On the other hand, significant difficulties arise if textbooks exclude theological claims in their case for evolution. So, whether textbooks include or exclude theological claims, they face debilitating problems. We attempt to establish this thesis by examining 32 biology (and evolution) textbooks, including the Big 12—that is, the top four in each of the key undergraduate categories (biology majors, non-majors, and evolution courses). In Section 2 of our article, we analyze three specific types of theology these texts use to justify evolutionary theory. We argue that all face significant difficulties. In Section 3, we step back from concrete cases and, instead, explore broader problems created by having theology in general in biology textbooks. We argue that the presence of theology—of whatever kind—comes at a significant cost, one that some textbook authors are likely unwilling to pay. In Section 4, we consider the alternative: Why not simply get rid of theology? Why not just ignore it? In reply, we marshal a range of arguments why avoiding God-talk raises troubles of its own. Finally, in Section 5, we bring together the collective arguments in Sections 2-4 to argue that biology textbooks face an intractable dilemma. We underscore this difficulty by examining a common approach that some textbooks use to solve this predicament. We argue that this approach turns out to be incoherent and self-serving. The poor performance of textbooks on this point highlights just how deep the difficulty is. In the end, the overall dilemma remains. https://journals.blythinstitute.org/ojs/index.php/cbi/article/view/44

bornagain77

Jerry @ 145 -

The Lancet study with its 96;000 patients is fake news because it evaluates HCQ out of context. So any conclusions about HCQ’s effectiveness is irrelevant because they used a bogus method to evaluate the drug.

I'm not sure "looking at whether people die" would be described as a bogus method for seeing if a drug works. That's about as primary as a primary endpoint can be. I also suspect that testing a drug on patients with COVID-19, when they start treatment within 48 hrs of a positive test is pretty much within the context of using a drug to treat a disease. Bob O'H

RavenT @ 151 -

However quite awhile ago one study did show zinc has improve the survivability of patient. Can we then assume HCQ and zinc does improve survivability against no treatment at all?

It doesn't look like it, although I'd caution against trusting any estimates too much. The study you mention compares HCQ + AZ + Zn to HCQ + AZ, and has an odds ratio of 1.53, i.e. the patients who received zinc in addition to HCQ and AZ were about 50% more likely to be discharged. The big study we're now discussing compares HCQ + AZ(*) to a control, and has an odds ratio for death of 1.45. That would suggest that using HCQ + AZ + Zn compared to neither has an odds ratio of 1.53/1.45 = 1.05, i.e. about a 5% greater chance of surviving. This is (a) not large, and (b) really uncertain. (*) actually AZ or equivalents. Bob O'H

RavenT: Near the bottom his full sentence is “So I’m taking the two: the zinc and the hydroxy” Thanks for that! JVL

You can find DT remark about his intake of HCQ in https://www.whitehouse.gov/briefings-statements/remarks-president-trump-roundtable-restaurant-executives-industry-leaders/ Near the bottom his full sentence is "So I'm taking the two: the zinc and the hydroxy" RavenT

Kairosfocus: There seems to be more and more reports saying HCQ has no beneficial (and maybe even detrimental) effects on COVID-19 patients. Also, there seems to be few new positive reports. So, I'm just wondering . . . what is your tipping point? Would a full-blown, gold-standard RCT showing HCQ is ineffective against COVID-19 change your mind? What about an RCT of HCQ + zinc? President Trump has said he is already taking HCQ (without zinc I believe) prophylactically; are you doing the same? And why. Thanks!! JVL

KF, My main argument is basically to show that since there is a study that show HCQ + Zinc has improved survivability compared to HCQ alone, we should be able to extrapolate it to say HCQ + Zinc has improved survivability compared to no treatment. I am also curious why the study about HCQ + Zinc doesnt seems to have alot of media exposure after 2 weeks than the study that show HCQ doesnt have any different to no control, which the media will trumpet it within hours, but to me that should be discussion for another time. RavenT

RT, kindly, scroll up to OP and work through it. Watch Dr Locano, and particularly note Dr Raoult's results. Go to the front page of the IHU site and learn a little about whose work is being systematically sidelined here. There is a reason why the two most populous countries and the two most populous in this hemisphere have -- along with a significant number of others -- given significant, emergency levels of approval for HCQ based cocktails in treatment of CV19. It is highly noteworthy that physicians and researchers suggesting its credible utility as a rule emphasise that early use is indicated; contrast studies that break the synergy in the cocktail and push the use to points where it is likely to be too late. Note, that eyewitness and patient reports or reasonably recorded cases are not mere dismissible bad or even no evidence, that tendency reflects a disregard for truth, and for sound prudence in empirically grounded warrant. Refusal to acknowledge this and similar dismissal of urgency and do no harm ethical concerns are all tellingly diagnostic. Indeed, we may note how, in critiquing the study on VA data, Dr Raoult specifically pointed out that in some cases where onward damage and complications are being addressed, the disease is in a post-viral phase where tests may not detect the virus. The general point is, we need to look very carefully at how we tend to think, believe and make decisions as a civilisation on matters tied to epistemology and associated inductive logic. The problems we are seeing with relatively accessible here and now issues extend a fortiori to questions on origins and sciences that study origins. We need to think again, before fatal disaffection sets in irreversibly. But then, if I take Machiavelli or Santana or Plato seriously, I should not be amazed to find that we ever so often march off the cliff as a civilisation. KF PS: Similarly, we must reckon that once pandemic broke out, large scale loss of life was unavoidable. So, for instance, CV19 kills, but so too, economic recession and depression. Just the suicide numbers and other deaths of despair are significant. In less developed parts of the world, famine, malnutrition and deterioration of health care are material. So, the issue is to reduce, not eliminate deaths. PPS: One of the plausible antiviral action modes of HCQ is promotion of Zn transfer into cells. kairosfocus

EG, what part of, Placebo controlled studies will take far too long in the teeth of a fast moving pandemic is so hard to understand? (As in, did you notice what Maryaline Catillon and Richard Zeckhauser cited from Dr Fauci on the implications of time/urgency?) Similarly, what part of it is harmful to give people suffering a fast-moving significantly fatal disease deliberately mislabelled sugar pills violates the core first do no harm principle is so implausible to you that you contemplate turning people into little more than lab rats as if it could be justified? (Guess who did that about eighty years ago, why?) Yet again, what part of a stitch in time saves nine is so abstruse, given the repeated point that delaying treatment undermines its efficacy? (Do I need to cite Machiavelli on hectic fever and the costs of undue delay?) Or is it that you are so sure that you and your ilk have so cornered the market on soundness that you don't need to do more than snip, snipe and type up shibboleths or talking points without bothering to consider that there may be more to the issue and consequences than you came here comfortably armed with? Something is seriously wrong, wrong in the face of actual harm being done. KF kairosfocus

RH7 et al, It is obvious that you are filtering out and dismissing without serious consideration, seemingly implausible evidence, argument and counsel that do not sit easily with the plausibility frameworks informed by currently dominant evolutionary materialistic scientism and/or fellow traveller ideologies, underlying worldviews and associated cultural/policy agendas. Several weeks ago, I pointed out issues, concerns and a sustainability oriented decision theory framework that would serve our civilisation far better in the face of pandemic. But of course, who is that IDiot to suggest something different from our comfortable Gold Standard approaches and shibboleths? The problem is, THIS IS NOT AN ACADEMIC EXCHANGE, we are dealing with a pandemic and with people dying of a fast moving highly contagious pandemic. That's why business as usual [BAU] is not likely to be a successful strategy. That is why ethical considerations such as do no harm and the CI/GR ethical premise that each person is a quasi-infinitely valuable neighbour and end in him-/her- self, not a convenient means to my -- or, "our" [i.e. our ideology's] -- end is pivotal. That's why prudence should be restored to centrality among intellectual virtues rather than selective hyperskepticism fed by ideologies as outlined. The consequences are playing out as we see the clearly rising trend beyond polarisation to fatal disaffection. Newsflash, the problem with humanity is not Western Civilisation or the lingering legacy of Christendom (often contemptuously equated to "fascism" which itself speaks to ideological distortions). No, it is the moral hazard of being human. In that context, the lessons of sound history were paid for with blood and tears. Those who neglect, dismiss, deride or demonise such doom themselves to pay the same coin over and over and over again. Fair warning. KF PS: I again highlight what you have so tellingly, insistently, willfully refused to engage in the days since it was first clipped at 56 above. That failure speaks to the fundamental, ideologically driven, deeply polarised way you have acted. Especially, as the core counsel being offered from members of the Kennedy School of Government is actually independent of the final balance on the merits of HCQ cocktails. Let us duly note the decision making, sound governance issues being put on the table:

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory.

kairosfocus

Some studies already have been done on hydroxychloroquine and the closely related chloroquine, including one published on Friday showing a higher risk of death and heart rhythm problems for coronavirus patients who used them compared to those who did not. But doctors are waiting for the debate about the usefulness of these drugs for COVID-19 to be settled by gold-standard scientific trials, with some results due as soon as next week. Such research involves randomized trials comparing these drugs to a placebo, with neither doctors nor patients aware of who gets what. Worldwide, many gold-standard trials are underway. They explore whether hydroxychloroquine can prevent or treat COVID-19, which patients might benefit, when treatment might start, how long it might continue and what dose might be best. The University of Minnesota may have some results next week. It is testing whether hydroxychloroquine prevents infection in people exposed to the coronavirus and whether it alleviates COVID-19 symptoms. Other placebo-controlled trial results are expected starting this summer. https://www.reuters.com/article/health-coronavirus-hydroxychloroquine-tr-idUSL1N2D41QV rhampton7

Hi, I am new to this forum. Just want to add-in on the discussion about HCQ. As I understand it alot of studies has shown it doesnt produce any effect. However quite awhile ago one study did show zinc has improve the survivability of patient. Can we then assume HCQ and zinc does improve survivability against no treatment at all? https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1 RavenT

How is it that Remdesivir can already have results from an RCT when the treatment devised by the French doctors was first to field? rhampton7

Another example, published in the New England Journal of Medicine... We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only. total of 1063 patients underwent randomization. The data and safety monitoring board recommended early unblinding of the results on the basis of findings from an analysis that showed shortened time to recovery in the remdesivir group. Preliminary results from the 1059 patients (538 assigned to remdesivir and 521 to placebo) with data available after randomization indicated that those who received remdesivir had a median recovery time of 11 days (95% confidence interval [CI], 9 to 12), as compared with 15 days (95% CI, 13 to 19) in those who received placebo (rate ratio for recovery, 1.32; 95% CI, 1.12 to 1.55; P<0.001). The Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo (hazard ratio for death, 0.70; 95% CI, 0.47 to 1.04). Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%). Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; ACCT-1 ClinicalTrials.gov number, NCT04280705. opens in new tab.) https://www.nejm.org/doi/full/10.1056/NEJMoa2007764?query=RP rhampton7

R7

However, if you’re the kind of person who thinking RCTs are not needed right now, then it’s very hard to dismiss this study without also dismissing the work of the French doctors whose study also has fundamental flaws.

But don’t hold your breath. Ed George

Clinical studies are being conducted AS patients are being treated. For example, in Ohio... Kettering Health Network is using three different clinical trials as they care for COVID-19 patients. IL-6 inhibitor ruxolitinib: This drug appears to slow immune system problems that occur in some COVID-19 patients. Convalescent plasma trial: Plasma donated by patients that have recovered from COVID-19 is given to current COVID-19 patients. The antibodies in the plasma support the patient’s recovery. This effort is being led by the Mayo Clinic. Remdesivir: An anti-rival drug, which has shown in preliminary trials to help COVID-19 patients recover more quickly “We’ve got a lot more testing available to us now, so it certainly allows us to test more of the patients in the hospital. It’s allowing us to start testing patients before surgery, and I think on a larger note it’s giving us a better idea of the prevalence of the disease within our communities,” said Infectious Disease Specialist Jeffrey Weinstein. https://www.wdtn.com/news/local-news/kettering-health-using-3-clinical-trials-in-treatment-of-covid-19-patients/ rhampton7

The Lancet study is a real study with limitations that the authors pointed out, as is customary (Note that those who support the French doctors do not do the same). They method they used is legitimate, but not determinative. For that you need RCTs. However, if you’re the kind of person who thinking RCTs are not needed right now, then it’s very hard to dismiss this study without also dismissing the work of the French doctors whose study also has fundamental flaws. rhampton7

The Lancet study with its 96;000 patients is fake news because it evaluates HCQ out of context. So any conclusions about HCQ’s effectiveness is irrelevant because they used a bogus method to evaluate the drug. It is being used probably knowingly in an invalid way. A lot of countries are having low mortality rates and associating it with use of HCQ soon after diagnosis. But not the US which is misusing it. jerry

KF

May 22, 2020 at 5:30 pm EG, again, you indulge in elevating a claimed gold standard and dismissing whatever does not fit but which would be instantly recognised as a business as usual vs alternative, apart from polarisation.

No, I am elevating a 96,000 strong high quality retrospective study above a much smaller, lower quality, retrospective study. Neither were rigorously controlled nor random. But if I am going to have to give weight to one, I will have to lean in favour of the larger, more comprehensive one. Ed George

Whatever EG, their overt, even hostile, political bias towards Trump, and the authors own words, undermines any credibility the study may have had as to drawing firm conclusions. It might seem more than a little prudent to not air open hostility towards a political opponent just one week before you release a study casting that political opponent in bad light, a study which according to the authors own words, was questionable in that "a cause-and-effect relationship between drug therapy and survival should not be inferred.” But hey, if we can't infer a cause and effect relationship, at least we can cast doubt on our political opponent, eh EG? Pathetic! Lancet has lost a lot of respect since it decided to get into politics. bornagain77

EG, again, you indulge in elevating a claimed gold standard and dismissing whatever does not fit but which would be instantly recognised as a business as usual vs alternative, apart from polarisation. And again, you dismiss the ethical failure of refusal to see what it means to give deliberately mislabelled sugar pills under solemn colours of medicine to those suffering a rapid acting, contagious significantly fatal disease. And yet again you point to sources that fail to deal with such issues even as you brush aside cumulative evidence of effective and responsibly safe treatment. I point others to the OP yet again, and will again append what you and too many others refuse to face regarding decision theory. KF PS: Again

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory.

kairosfocus

BA77

Rhampton7; claims the Lancet is ‘not fake’.,,, Yet, In the authors own words,... [they provide possible weaknesses in their interpretations of the data]

Is it really necessary to point out the inanity of this statement? Ed George

KF

PS: I again point to what Dr Raoult is, what he directs and the accumulation of evidence on this case.

Yes, he represents a single non-controlled retrospective study, and you buy it hook, line and sinker. But when a more comprehensive high quality retrospective study covering a far greater number of patients fails to find a benefit, you choose to ignore it. And you accuse others of not following the evidence. Ed George

Rhampton7; claims the Lancet is 'not fake'.,,, Yet, In the authors own words, from the new study in the Lancet that supposedly conclusively showed Hydroxychloroquine to be harmful,,,

"Our study has several limitations. The association of decreased survival with hydroxychloroquine or chloroquine treatment regimens should be interpreted cautiously. Due to the observational study design, we cannot exclude the possibility of unmeasured confounding factors,,,, , a cause-and-effect relationship between drug therapy and survival should not be inferred. These data do not apply to the use of any treatment regimen used in the ambulatory, out-of-hospital setting." https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext

Also of note, The Lancet has a history of political bias such as being anti-Israel.. In regards to potential bias in the current study, they have recently expressed open hostility towards Donald Trump:

"On 16 May 2020, The Lancet published an article on the US Centers for Disease Control (CDC) that, amongst other things,,, concluded with a call to the American people to elect someone other than Trump in November 2020. https://en.wikipedia.org/wiki/The_Lancet#Reviving_the_US_CDC

If there was any study that was ever ripe for suspicion of political bias, this one is it! bornagain77

BO'H, It is clear that what is going to happen is that vulnerable people will continue to pay a horrific price for the ever deepening polarisation in our systems. The mere evidence and logical balance will not resolve the issue, it is going to be the lottery of fatal disaffection. Our situation reminds me unhappily of 1914 and 1989, or 628. KF PS: I again point to what Dr Raoult is, what he directs and the accumulation of evidence on this case. kairosfocus

kf @ 128 -

BO’H, you are falling into selective hyperskepticism, gold standard evidence form. Accordingly, I draw your attention to the following, as has been pointed out since 56.

Yes, and as I pointed out @ 70 they are calling for high-quality case-control studies, and these have been done, and show no effect. The study RHampton7 points out @132 is also precisely the sort of study that's being asked for in the piece you keep on linking to. Why do you keep on linking to an article asking for high-quality retrospective studies as a counter-argument to high-quality retrospective studies? It makes no sense. Bob O'H

RH7, Jerry is pointing out the stitch in time issue. By the time people are admitted to hospital under pandemic conditions, the virus has already multiplied and wreaked havoc, with complications coming along for the ride. Something that has been on the table for months now, and has enough telling force that the FDA is now visibly backing down. Lancet and others need to pay heed to linked questions of prudence and especially the need for timely, ethically sound and credibly effective treatment, where deliberately mislabelled sugar pills given to vulnerable people fighting a fast moving killer disease in the name of an alleged gold standard testing method cannot be excused; but then, the value of life has been severely eroded through decades of the worst holocaust in history -- 800+ million of our living posterity killed in the womb, at a rate now a little under a million per week. To enable which, key institutions have been corrupted under false colour of laws, etc. Frankly, all of this is beginning to sound like macroeconomics and linked policy debates in the 70's - 80's. It took a lot of time for the polarisation to settle out enough for things to be clear, and as usual vulnerable people paid the price. KF PS: You are still evading the force of the point put on the table by the folks from Harvard's Kennedy School:

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory.

kairosfocus

Jerry, the study was posted on Lancet, so it’s not fake. You’re right that it is not as accurate as definitive as an RCT. That’s why RCTs need to be done. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext rhampton7

Very few rigorous trials of the drug have reported data. Some people were given the drug in studies in which there wasn’t a control group that got placebos, and results from some of those studies have been mixed, with some reporting benefits, others showing no effect, and some indicating that the drugs may even be harmful for some patients. Even the latest data from the large multinational study in the Lancet combined studies that used the drugs in different doses and in different ways that may not be directly comparable. Early evidence from tests of the drug points to hydroxychloroquine having no effect in combatting the disease in seriously ill patients (SN: 4/21/20). The large Lancet study also failed to show any benefit. But just because the drug didn’t seem to help in late stages of the disease, that doesn’t mean it won’t be effective if given early, perhaps even before people are exposed to the virus, Avidan says. That’s exactly what researchers are attempting in multiple trials testing the drugs effectiveness as a preventative, or prophylactic, treatment for the coronavirus. Some of those trials are just wrapping up — including two trials at the University of Minnesota — but aren’t reporting results yet. Others are still under way. https://www.sciencenews.org/article/coronavirus-covid-19-politics-hydroxychloroquine-treatment-research rhampton7

More fake news by Rhampton. It's a hospital study. And no mention of zinc. jerry

The new study, led by investigators at Brigham and Women's Hospital Center in Boston, included data from 671 hospitals on six continents. Researchers compared the outcomes of nearly 15,000 COVID-19 patients received the drug or a similar compound, chloroquine, plus an antibiotic with those of about 81,000 COVID-19 patients who had not received the drugs. It was an observational study, meaning patients were not randomized to get a particular drug or a placebo. “ We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with" an antibiotic, the study authors wrote. What's more, the patients who got the drugs were more likely than the others to die in the hospital. The study authors called for high-quality, randomized clinical trials to confirm any harms or benefits of the medication. "In the meantime, we suggest these drugs should not be used as treatments for COVID-19 outside of clinical trials," Dr. Mandeep Mehra, lead author of the study and the executive director of the Brigham and Women's Hospital Center for Advanced Heart Disease in Boston, said in a statement. https://www.nbcnews.com/health/health-news/another-large-study-finds-no-benefit-hydroxychloroquine-covid-19-n1212886 rhampton7

EG,if you had followed carefully, "in hospital . . ." would be a clue to the stitch in time . . . NOT . . . factor. The repeated attempt to drown out accumulating evidence is itself sending a message. KF PS: Meanwhile, here yet again is what is highly material and ever so tellingly studiously ignored . . . something that would still be material even were HCQ cocktails the sort of dangerous and ineffective exercises in poisoning oneself they are being luridly portrayed as:

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory.

PPS: I think it was von Hayek who said that one cannot make proper sense of how things could go wrong unless he had first worked out how they could ever go right. He said it on Economics, another context in which vast controversy has been amplified; needlessly undermining trust in what is fundamentally sound and at great cost to the vulnerable. A lesson in itself, written in blood and tears. kairosfocus

We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext

Ed George

Eh? This is what is says in the abstract:

The abstract does not say who the patients were. If they were hospitalized then they were inappropriate subjects. That has been the debate all along, how to prevent hospitalization. Do you know if these patients were not hospitalized?

Nope, nothing there gives the conditions you gave

I provide the mission statement of the FDA. The conditions I listed flow from that mission statement. Maybe you can delineate other more appropriate conditions. What is there besides safety and effectiveness that should be considered? The United States Food and Drug Administration (FDA) will generally only approve a new treatment as safe and effective for wider use if results indicate that the effects of the drug are in line with its claims, and if these benefits occur without causing unsafe adverse effects Safety is not an issue. If it it then debate it. Effectiveness is the issue but since the alternative is doing nothing, there is nothing lost in using it. jerry

BO'H, you are falling into selective hyperskepticism, gold standard evidence form. Accordingly, I draw your attention to the following, as has been pointed out since 56. Your crying no evidence in the teeth of potentially lifesaving evidence on the table is a serious matter. And in case you think my having made reference to decision theory is a dismissible idiosyncrasy, the article is coming out of the Kennedy School of Government. KF PS: I note:

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory.

kairosfocus

Jerry @ 118 - Yes, I have read the references. How do you come to your conclusion that they don't support my point?

One is a large meta analysis but does not say what was analyzed.

Eh? This is what is says in the abstract:

We searched PubMed, Embase, the Cochrane Library, Web of Science, medRxiv, and other relevant resources until May 13, 2020. We included randomized controlled trials and observational studies in which hydroxychloroquine was adminstered and compared to a control group. Data were extracted, and quality assessment of the studies was carried out. We evaluated symptomatic progression, mortality, viral clearance, the evolution of changes on chest CT imaging, and adverse events

So, they looked at "observational studies in which hydroxychloroquine was adminstered", and analysed "symptomatic progression, mortality, viral clearance, the evolution of changes on chest CT imaging, and adverse events".

The mission statement of the FDA is safe, effective and quality control. Any testing whether a RCT or otherwise would be to meet these mission statements. https://bit.ly/3ebNesz

Nope, nothing there gives the conditions you gave @ 32. It might be good to admit that you just made these conditions up. Bob O'H

kf @ 117 -

BO’H, at this point, I do not expect responsiveness to evidence due to the media and elite hysteria whipped up and following manifestly flawed attitudes to ethical and inductive logic issues.

That's because you don't provide any evidence of effectiveness. What evidence did the FDA use to change its stance? Was it anything other than Trump taking it? It looks to me like a political decision, but I'd be happy to be shown wrong. Your other evidence is a survey. In case you haven't notice, the effectiveness of drugs to treat disease isn't decided by a vote. If it did, beer would be the cure for the common cold. Bob O'H

Dr. Kevin Tracey said if famotidine works -- and that's a big if at this point -- it would be easy to use it on a widespread scale. "It's generic, it's plentiful and it's inexpensive," he said. But he emphasized that it might not work. "We don't know if it has any benefit. We really don't. I swear we don't," he said. "People are hoping for anything. But we need to do this clinical trial." ————- Kevin J. Tracey, a neurosurgeon and inventor, is the president and CEO of the Feinstein Institute for Medical Research, professor of neurosurgery and molecular medicine at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and President of the Elmezzi Graduate School of Molecular Medicine in Manhasset, New York. The Public Library of Science Magazine, PLOS Biology, recognized Tracey in 2019 as one of the most cited researchers in the world. rhampton7

Start taking Pepcid or heed the warning of the study’s authors (applies equally to hydroxychloroquine) Among the 1,536 patients in the study who were not taking famotidine, (aka Pepcid) 332, or 22%, either died or were intubated and put on a ventilator. Among the 84 patients who were taking famotidine, 8, or 10%, died or were put on a ventilator. "Compared to the rest of the patients, those who received famotidine had a greater than 2-fold decreased risk of either dying or being intubated," according to a statement by authors of the study at Columbia University Irving Medical Center. "Based on what we've learned in this study, it's encouraging," said Dr. Joseph Conigliaro, a coauthor of the paper and a physician at Northwell Health. "This association is actually really compelling." The drug, famotidine, has been on the market for nearly 40 years and is an active ingredient in the popular over-the-counter heartburn treatment Pepcid. Based on these results, Conigliaro said he knows that doctors might start prescribing famotidine to their coronavirus patients now, before the results of the clinical trial are known, but he doesn't recommend it. "I think doctors should wait for more data from the prospective trial," he said. He added that there's no evidence famotidine prevents infection, and "I would really caution against this. Taking famotidine might give them a false sense of security," he said. Only a clinical trial, where patients are randomly assigned to get either famotidine or a placebo and then studied, can determine if the drug really works against COVID-19. https://www.news.meredithlmg.com/tncms/asset/editorial/791a9514-c746-5c99-ae98-dd53d083003f/ rhampton7

Doctors in Italy have finally began widely prescribing hydroxychloroquine in certain combinations in Rome and the wider region of Lazio with a population of around six million. According to Corriere della Sera, a well known Italian daily newspaper, Dr. Pier Luigi Bartoletti, Deputy National Secretary of the Italian Federation of General Practitioners, explains that every single person with Covid-19 that has early signs, like a cough or a fever for example, is now being treated with the anti-malaria drug. The drug “is already giving good results,” Bartoletti says while Malaysia reveals they have been using it since the very beginning. Bartoletti further adds that the drug: “Must be used with all the necessary precautions, it must be evaluated patient by patient. It can have side effects. But those that take it are responding really well.

Must be fake news, cannot possibly be true. Who are you going to believe, Dr. Bartoletti or Joe Scarborough? https://bit.ly/3cUmYCS Another crazy doctor from Italy who refused to participate in a RCT because it is unethical.

What is more incredible are the statements of Professor Christian Perronne, Head of the Infectious Diseases Department at the Garches University Hospital, made in an interview with a French weekly magazine. Referring to the European Discovery trial in which UK is taking part with only 800 patients, Perronne says: “I refused to participate because this study provides for a group of severely ill patients who will only be treated symptomatically and will serve as control witnesses against four other groups who will receive antivirals. It is not ethically acceptable to me... the protocol model chosen will not provide results for several weeks. Meanwhile, the epidemic is galloping. We are in a hurry, we are at war, we need quick assessments. America is to start yet another study which is to take one month even while one thousand people or more are dying worldwide today. “Even though the overwhelming evidence from large randomized studies is still lacking, I am in favor of a broad prescription for the following reasons: 1. We have a large body of evidence showing that in vitro hydroxychloroquine blocks the virus. We also have several clinical results indicating that this product is beneficial if administered early and we have no mention that it harms or is dangerous in this infection (only one study, poorly detailed, Chinese, on 30 patients with control group, did not observe any benefits but also no harmful effects). What is the risk of administering chloroquine straight away: nothing! 2. This drug is very inexpensive 3. It is well tolerated in long-term treatment. Personally, I have successfully used it clinically in the chronic form of Lyme disease for 30 years at a dose of 200 mg or even 400 mg/day... What are we waiting for? To have more dead?”

jerry

Another clinical trial of an alternative — don’t they know it’s all for naught? KF has unequivocally determined the proper treatment without resorting to an RCT! The HonorHealth Research Institute and HonorHealth in collaboration with the nonprofit research institute TGen are starting a clinical trial to use a combination of an antimalarial drug called atovaquone and the antibiotic azithromycin in patients with moderate-to-severe COVID-19 infection. “We know that a related regimen like hydroxychloroquine and azithromycin is being tried in clinical trials around the world and one of the problems with that regimen is that it can cause some cardiac toxicity,” said Dr. Sunil Sharma, one of the clinical trial’s principal investigators with dual appointments at HonorHealth Research Institute and TGen. “Atovaquone and azithromycin is relatively safer compared to that regime.” Translational Genomics Research Institute (TGen) is a Phoenix, Arizona-based non-profit organization dedicated to conducting groundbreaking research with life-changing results. TGen is affiliated with City of Hope, a world-renowned independent research and treatment center for cancer, diabetes and other life-threatening diseases. https://chamberbusinessnews.com/2020/05/21/arizona-researchers-study-safer-treatment-option-for-coronavirus/ rhampton7

“ has shown some effect but the reports are rather circumspect in claims.” Exactly the same with the French doctors treatment. rhampton7

RH7, strawman. Alternatives are always open. Remdesivir has shown some effect but the reports are rather circumspect in claims. KF kairosfocus

By KFs standards, Remdesivir should be standard protocol and the ongoing RCTs can be stopped... Both Dr. Faylor and Lemos would spend weeks in the hospital, much of that time sedated as doctors and nurses did all they could to keep them alive while their bodies fought the virus. Both families were approached and asked if they would consent to their loved one taking part in a new clinical trial only available to hospitalized patients with confirmed cases of COVID19. The clinical trial testing Remdesivir versus placebo was on the fast track as a potential drug therapy in treating COVID-19 with some early promising results. Their families agreed to their participating in the study, not knowing if their loved one would get the drug or not. As it turns out Dr. Faylor did receive the medication, something he credits for saving his life. Lemos did not, but is glad his family was willing to enroll him in the trial. “Clinical trials are a way to help everybody, and even though I didn’t get the medication, I would still participate if given the opportunity,” Lemos said. Dr. Faylor agrees. “I’m sure Remdesivir helped me and if the shoe was on the other foot I would do the same for my family member,” Faylor said. “The medications used in clinical trials are usually studied for years before being tested in humans thus the fact we were able to complete this large trial in less than two months is a major advance in the discovery of new treatments,” Andre Kalil, M.D., physician and primary investigator of the National Institutes of Health clinical trial of Remdesivir at UNMC, said. https://www.siouxlandproud.com/community/health/coronavirus/two-unmc-clinical-trial-participants-recount-their-brush-with-covid-19/ rhampton7

Jerry – see my comments @ 44, 70 and 73. And have you found the FDA document that you claim give the conditions for RCTs that you set out

Your references do not support your point. Have you read them? One is a large meta analysis but does not say what was analyzed. So it is hard to know just what stage of the disease is being analyzed. The mission statement of the FDA is safe, effective and quality control. Any testing whether a RCT or otherwise would be to meet these mission statements. https://bit.ly/3ebNesz

The Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation.

jerry

BO'H, at this point, I do not expect responsiveness to evidence due to the media and elite hysteria whipped up and following manifestly flawed attitudes to ethical and inductive logic issues. Accordingly, I will simply cite a current data point relevant to the US, specifically, what the FDA just did:

FDA appears to soften stance on hydroxychloroquine after Trump says he takes malaria drug Published Tue, May 19 2020 1:41 PM EDT Updated Tue, May 19 2020 2:33 PM EDT Berkeley Lovelace Jr. The U.S. Food and Drug Administration said Tuesday that taking hydroxychloroquine is "ultimately" a choice between patients and their health-care providers, appearing to soften its earlier advisory against taking the anti-malaria drug outside of a hospital. "The decision to take any drug is ultimately a decision between a patient and their doctor," FDA Commissioner Dr. Stephen Hahn said in a statement to CNBC. "Hydroxychloroquine and chloroquine are already FDA-approved for treating malaria, lupus, and rheumatoid arthritis." The comments came a day after President Donald Trump said he has been taking hydroxychloroquine daily for over a week to prevent infection from the coronavirus. [--> in a context of contact or proximity with WH staffers who have contracted the disease] He said he asked his White House physician about the drug. "I asked him, 'What do you think?' He said, 'Well, if you'd like it.' I said, 'Yeah, I'd like it. I'd like to take it.'"

If it was the sort of evidential slam-dunk that the drug was ineffective and potentially highly dangerous as has been trumpeted for weeks now, there is no way the FDA would be visibly backing away from the sort of ferocious warnings it was issuing only several weeks ago. Instead, it is obvious that the weight of evidence that the cocktail, taken early enough under physician supervision is often highly effective is eroding the phalanx of elite and media pushback we have seen ever since Mr Trump suggested that this drug [cocktail] and Remdesivir had some promise. And going back to early April, shortly after the phalanx formed up, it is interesting to see a summary of physician opinions reflective of their estimates of likely effectiveness and reasonable safety:

65 Percent of Physicians in New Survey Would Give Anti-Malaria Drugs to Their Own Family to Treat COVID-19 ATLANTA, April 8, 2020 /PRNewswire/ -- Sixty-five percent physicians across the United States said they would prescribe the anti-malaria drugs chloroquine or hydroxychloroquine to treat or prevent COVID-19 in a family member, according to a new survey released today by Jackson & Coker, one of the country's largest physician staffing firms. Only 11 percent said they would not use the drug at all. Meanwhile, 30 percent of the surveyed doctors said they would prescribe the medications to a family member prior to the onset of symptoms if they had been exposed to COVID-19, a highly contagious virus that causes a pneumonia-like infection of the lungs. "Working in healthcare, we've learned the best way to get a candid perspective on treatment options from a physician is to ask: 'Would you give this to your family?'" said Tim Fischer, President of Jackson & Coker. "Families across the U.S. – and the world really – want to know what they can do to protect and save their loved ones." Jackson & Coker conducted the survey of 1,271 physicians from 50 states from April 4 to April 7. It conducted the survey not to influence the debate in treating patients with anti-malarials but to make sure the voice of physicians is represented. It has a margin of error of +/- 3 percent with a 95 percent confidence level of the doctors surveyed. Chloroquine and hydroxychloroquine have been on the market for many years and treat several different forms of malaria. Hydroxychloroquine, however, is also used to treat lupus and rheumotoid arthritis. The two anti-malaria drugs were given emergency approval for off-label usage by the Food and Drug Administration last week to treat COVID-19. Assuming there were no clinical contraindictions, physicians were asked if they would prescribe or have another doctor prescribe either chloroquine or hydroxychloroquine off label if a family member developed symptoms of COVID-19. While 54 percent responded yes, another 11 percent said they would if the disease became serious. Twenty-four percent said they would need more data to decide; another 11 percent said they would not prescribe it. Among the specialties most willing to utilize the anti-malarials were anesthesiologists, surgery subspecialists, physicians in diagnositic medicine, women's medicine, internal medicine and hospital-based medicine. Physicians who were more cautious and wanted more data about using the anti-malarials to treat COVID-19 tended to be doctors under the age of 45, academics and those who practice medicine in a healthcare system. Among hotspots states where there are the highest per-capita cases of COVID-19, physicians in New Jersey, Louisiana, Washington and Michigan showed the greatest support for usage of the medication for a family member or themselves. In New Jersey, for example, 77 percent of doctors said they would prescribe for a family member early in an illness. In New York, 53 percent of doctors said they would prescribe for a family member. In Louisiana, 69 percent said they would prescribe for a family member, and 60 percent of doctors in Michigan said they would prescribe for a family member. Jackson & Coker also found that 67 percent of surveyed physicians said they would take the medications themselves to treat COVID-19. Fifty-six percent said they would take the anti-malarial if they displayed symptoms, and another 11 percent said they would take the medications if they got very sick from the virus. "When a medical crisis like this emerges, the voice of physicians needs to be heard. Their insight is powerful for families faced with uncertainty," Fischer said.

The sustained trend is clear, and it is clearly consistent with Dr Raoult's cumulative pattern of results. KF kairosfocus

Welcome Back JVL, I was wondering where our favorite Corona Virus Cheerleader went. ;) Andrew asauber

A Wisconsin woman with lupus has taken hydroxychloroquine for 19 years and still got COVID-19

https://www.msn.com/en-us/health/medical/a-wisconsin-woman-with-lupus-has-taken-hydroxychloroquine-for-19-years-and-still-got-covid-19/ar-BB14qnpE JVL

kf - Yes, there numbers are there in the case-control studies. The lack of effect of HCQ has bee replicated (albeit not with RCTs). Jerry - see my comments @ 44, 70 and 73. And have you found the FDA document that you claim give the conditions for RCTs that you set out @ 32? Bob O'H

He’s been curiously silent about the review of high quality case-control studies that suggests no curative effect, and a higher risk from side effects.

Why don't you present all this information. I am unaware of any nor have I seen any presented elsewhere. And I have looked and so has Rhampton who has not presented it even though he has presented close to 50 internet reports. jerry

BO'H, the numbers are clearly there and the pattern of action is clearly there. The issue of studies that tilt the field is there too, note FDA's backing current off. KF kairosfocus

You know that the French doctors did not do an RCT (and apparently are not doing one currently), That’s why, among other reasons, RCTs are done.

Raoult isn't even doing a case-control study. And kf keeps on citing a piece that says that high quality case-control studies are what are needed. He's been curiously silent about the review of high quality case-control studies that suggests no curative effect, and a higher risk from side effects. Apparently he's not interested in case-control studies, of whatever quality. Bob O'H

Jerry, in some cases, they are unethical as violating the do no harm principle. It seems ethics are at a sadly steep discount today and we need to learn somewhat regarding responsible inquisitiveness vs vicious curiosity and other intellectual virtues/vices. In the extreme case, more lives were saved by the knowledge gained through the holocaust than were lost in it but the taint was an unbearable ethical contradiction. A decades long effort was engaged to recreate the knowledge in an ethically sound manner. In our case, the proposed gold standard investigations will directly expose people to ravages of a deadly, highly contagious disease through deliberately mislabelled sugar pills or the like; something no consent form can erase. Similarly, by dismissing evidence in hand and refusing to make due distinctions while advocating a process that implies long delays, hundreds of thousands of plausibly avoidable deaths have been put in train. Of course, it is imagined that evidence in hand is poor or is not real evidence. That points to selective hyperskepticism and its harmful consequences. We need to recognise that hyperskepticism and the like are not intellectual virtues and return to the virtue of prudence. KF PS: Pharmacology is the study of poisons in small doses. kairosfocus

No one is against RCTs per se. It is just that. they are not necessary in every case to make a good decision. Timing is critical for several hundred thousand unknown people who will die if they are not given an effective treatment. We know the numbers. We are understanding approximately the number of people that will die if there is no treatment. And "no treatment" for the virus is the the standard treatment now recommended by the medical community. In such a situation the use of a treatment that has promise is mandatory. Not just HCQ + but any other treatment that has proven beneficial. I can provide a dozen alternatives that have shown some positive effects so no one is advocating HCQ as the only possibility. To insist on RCTs is cynical at best because it takes months to implement even at its fastest. To argue against HCQ one has to argue that it is not safe or effective. We know the CDC and WHO have recommended the drug for prophylactic use so it can not be considered dangerous. I was given the drug prior to a trip to Africa 6 years ago. Yes, some may have an adverse reaction but some have an adverse reaction to over the counter drugs. Some people cannot take common pain killers such as aspirin, ibuprofen or acetaminophen (the last known better as Tylenol could kill with an over dose.) We know HCQ + is effective in that there are a myriad number of positive results with no negative results when used appropriately. The HCQ combinations are used most effectively in the first 10-12 days after infection when the viral load is low.. So the drug combinations are effective. To argue that it is not 100% effective is specious at best as any treatment will not be universal. So anyone arguing against HCQ + should do so on the basis of safe and effectiveness. Presenting negative opinions or the odd negative occurrence, or the failure in inappropriate situations is not a valid argument. But that is what we are getting. For example, all the reports from the VA are irrelevant for proving negative results. Any report from hospitalization is irrelevant for proving negative effects. But we are still getting these reports in comments here. jerry

The research, which was published in the medRxiv online depository (https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf) x evaluated data from 368 COVID-19 patients. The study, which was paid for by grants from the National Institutes of Health and the University of Virginia, has not been peer-reviewed. “We performed a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers until April 11, 2020,” the researchers explained. Some 97 patients had been treated with just hydroxycholoroquine, 113 were treated with hydroxycholoroquine and the antibiotic azithromycin and 158 received “standard supportive management” for COVID-19. ACKNOWLEDGMENTS This work was supported by National Institutes of Health (USA) grants (R01EY028027 and R01EY029799), DuPont Guerry, III, Professorship, and University of Virginia Strategic Investment Fund to JA. The funders had no role in study design or conduct, data collection, analysis, or interpretation, manuscript writing, or the decision to submit the manuscript for publication. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, U.S. Department of Veterans Affairs, nor does mention of trade names, commercial products, or organizations imply endorsement by the United States government. This paper represents original research conducted using data from the Department of Veterans Affairs and is, in part, the result of work supported with resources and the use of facilities at the Dorn Research Institute, Columbia VA Health Care System, Columbia, South Carolina. https://www.foxnews.com/science/covid-19-hydroxychloroquine-showed-no-benefit-more-deaths-va-virus-study rhampton7

here’s a preprint from NYU on the combination of HCQ/azithromycin and HCQ/azithromycin/zinc. It’s a retrospective of 411 patients with the addition of zinc sulfate (220mg, b.i.d.) and 521 on the dual combination. The main finding of this study is that after adjusting for the timing of zinc therapy, we found that the addition of zinc sulfate to hydroxychloroquine and azithromycin was found to associate with a decrease in mortality or transition to hospice among patients who did not require ICU level of care, but this association was not significant in patients who were treated in the ICU. This result may be reflective of the proposed mechanism of action of zinc sulfate in COVID-19. Zinc has been shown to reduce SARS-CoV RNA dependent RNA polymerase activity in vitro [13]. As such, zinc may have a role in preventing the virus from progressing to severe disease, but once the aberrant production of systemic immune mediators is initiated, known as the cytokine storm, the addition of zinc may no longer be effective [17]. Our findings suggest a potential therapeutic synergistic mechanism of zinc sulfate with hydroxychloroquine, if used early on in presentation with COVID-19. However, our findings do not suggest a prophylactic benefit of zinc sulfate in the absence of a zinc ionophore, despite interest in this therapy for prevention. A prophylactic strategy of zinc sulfate should be evaluated to help answer this question. This study has several limitations. First, this was an observational retrospective analysis that could be impacted by confounding variables. This is well demonstrated by the analyses adjusting for the difference in timing between the patients who did not receive zinc and those who did. In addition, we only looked at patients taking hydroxychloroquine and azithromycin. We do not know whether the observed added benefit of zinc sulfate to hydroxychloroquine and azithromycin on mortality would have been seen in patients who took zinc sulfate alone or in combination with just one of those medications. We also do not have data on the time at which the patients included in the study initiated therapy with hydroxychloroquine, azithromycin, and zinc. Those drugs would have been started at the same time as a combination therapy, but the point in clinical disease at which patients received those medications could have differed between our two groups. Finally, the cohorts were identified based on medications ordered rather than confirmed administration, which may bias findings towards favoring equipoise between the two groups. In light of these limitations, this study should not be used to guide clinical practice. Rather, our observations support the initiation of future randomized clinical trials investigating zinc sulfate against COVID-19. https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1.full.pdf rhampton7

“The VA study followed a week later, finding that patients who received HCQ not only saw no benefit but died more often than those who didn’t receive it“ There was no VA study this was debunked by the head of the VA yesterday. Vivid vividbleau

Alternatives the Indian Council of Medical Research (ICMR) is conducting an observational study in which five hospitals have been enrolled to assess the efficacy of the anti-malarial drug hydroxychloroquine as a preventive medication against COVID-19 among healthcare personnel. Hydroxychloroquine is one among the four treatment protocols that are being evaluated during the randomized controlled clinical trials under the WHO's Solidarity trial to find an effective treatment for COVID-19 across select hospitals. The other three treatment protocols are remdesivir, a combination of lopinavir and ritonavir, and lopinavir and ritonavir with interferon beta-1a. Hydroxychloroquine is an old and inexpensive drug used to treat malaria. India is the largest producer of the drug globally. https://www.devdiscourse.com/article/health/1059908-icmr-mulling-revision-of-recommendation-to-use-hcq-for-covid-19-treatment rhampton7

There is no proven alternative, that’s your reasoning? You want an available alternative to be RCT but not the French doctors treatment? Again, using your standard of absolute immediate need with no regard to the very near future, Remdesivir IS an alternative. Again, Coronavirus will be with us for at least a year, and might be cyclical. Dozens of other scientists and institutions are doing the very thing you say is unnecessary. Again, the results of these ongoing RCTs will tell us what the French doctors won’t. Pray for the best outcome, but don’t be surprised if it doesn’t live up to the hype. rhampton7

RH7, the Kennedy School of Government Decision Theory analysis is not made by French doctors, and it is an exercise in sustainability driven decision-making; in its core, it closely parallels my own made here at UD weeks ago. Extending slightly, there is always a Boyd OODA loop, and we seldom have clean, complete information or options. I have often discussed in terms of a two-track solution: quick & dirty now to hit the surge of a crisis, then as part of that build a bridge to an onward long term answer. In making the initial response, we recognise that CV19 is a fast spreading, quick-acting too often fatal disease, especially for vulnerable groups. Where, often, the killing mechanisms are in effect consequences and/or complications of the early progress. In at least some fatal cases, death occurs in a post-viral phase. Other groups, however [esp. the relatively young and prime of life] can shrug it off, though there is onward information of relapses or re-infections. Multiple strains points to rapid mutation, typical of RNA viruses. One implication is that long term mild strains will emerge and spread globally, turning CV19 into in effect another form of the common cold. Another is that vaccination is iffy, similar to the failure to achieve a widely effective vaccination against other corona viruses. In such a situation, there is a natural, baseline treatment, effectively that for Flu with complications. That is, not very effective, as dozens of thousands of annual Flu deaths in the US, likely implying hundreds of thousands globally imply. But it is business as usual. We desperately need broadly acting, cost effective, reasonably safe antivirals. Especially in an age of pandemics. Against that BAU, we have emerging potential alternatives. Here, a cascade of empirical evidence counts: in vitro chemical effectiveness studies, construction of plausible mechanisms of action [for this case, multiple . . . which is good as it makes resistance much harder to build up], animal analogues, clinical "side effect" discoveries [anti-inflammatory impacts], clinical case trends, off label results, various types of clinical and statistical studies. Where, the alleged gold standard is ethically dubious here as giving vulnerable people with a fast acting killer deliberately mislabelled sugar pills is a patent failure of the do no harm principle. So is, shifting regimes to load the likely outcomes or misrepresenting too late treatments as casting doubt on the efficacy of timely treatment -- which clearly happened with the VA study. That is manifestly why Dr Raoult and co have used cumulative clinical evidence and the cumulative result you keep evading is that from 24 to 3000+ patients there is a consistent result of rapidly progressive relief and tied virus clearance once the cocktail is given early enough. The cumulative data indicate 80 - 90+% reduction in death rates over the de facto BAU baseline. There is no proven alternative and there is a growing body of effective evidence that is well beyond the law of large numbers threshold, as well as allowing for stratification and calibration against relevant demographic profiles etc. In that context, there is a parallel BAU track record that is just as big enough for responsible decision making. Just scroll up to OP and click the onward link for the current score. Many weeks ago now, at latest by the 80 patients stage given further cases across the world, there was good enough data. There was absolutely no reason to insist on trying to create an artificial baseline as though comparison with such gives cumulatively better evidence than what obtains naturally, and as though it is irrelevant that placebo based studies would take many months, above and beyond violating do no harm. We need to recognise that we have not acted wisely, and that our collective willful obfuscation of evidence and the balance we term prudence have likely cost hundreds of thousands their lives needlessly. And that's before the additional toll of dragging out lockdowns beyond reason comes to bear. Recession and depression cost lives also and we need to minimise overall loss of life. Surely, we can do better than this. KF kairosfocus

Let’s run through the recent history of hydroxychloroquine trials. There were some small yet encouraging studies from China early on regarding its possible efficacy, but by far the biggest news in HCQ’s favor was the French study in March led by Dr. Didier Raoult that claimed to find remarkable success with the drug in treating COVID-19. Amid all the hype from that result, though, some critics began questioning the study’s methodology; they found enough flaws in it that the journal that published it later admitted that it didn’t meet their standards and shouldn’t have run. That was weeks after Trump had made hydroxychloroquine a global sensation by touting it repeatedly in public appearances as a potential miracle cure. In mid-April a small French study found no difference in deaths or ICU admissions between coronavirus patients who had received hydroxychloroquine and those who hadn’t. The VA study followed a week later, finding that patients who received HCQ not only saw no benefit but died more often than those who didn’t receive it. A few days after that preliminary data from a study of 22 different New York City hospitals found that HCQ recipients were no more likely to survive than those who didn’t receive it. Ten days ago a separate study of patients at New York-Presbyterian Hospital-Columbia University Irving Medical Center also found no benefit from the drug. The jury’s still out. All of the studies done so far were either observational rather than clinical or of sufficiently small scale that we can’t feel too confident about the results. Few if any of them involve patients getting getting a placebo to help doctors compare how those who received HCQ fared by comparison. https://hotair.com/archives/allahpundit/2020/05/19/trump-va-study-showing-deaths-among-hydroxychloroquine-recipients-trump-enemy-statement/ rhampton7

A Swedish study found that just 7.3 percent of Stockholmers developed COVID-19 antibodies by late April, which could fuel concern that a decision not to lock down Sweden against the pandemic may bring little herd immunity in the near future. Sweden's approach, shaped by a conviction the coronavirus can be slowed but not fully suppressed, is reflected not just in an aversion to quarantines and closures but in a decision to carry out relatively little testing and contact tracing. Tests are largely restricted to hospitalised cases and health care workers. Weekly test numbers still run at less than a third of the government's goal of 100,000, a far lower per capita rate than Sweden's Nordic peers and below that of most West European countries. Meanwhile the death toll has continued to rise, compounded by a failure to protect the old and infirm in a country famed for its welfare state. The government remains adamant that Sweden's high per capita death toll did not result from the lack of a national lockdown. https://kdal610.com/news/articles/2020/may/20/swedish-antibody-study-shows-long-road-to-immunity-as-covid-19-toll-mounts/1020501/?refer-section=health rhampton7

RHampton:

That’ll give us some basic sense of whether the drug works as a prophylaxis against the disease.

HCQ is only a prophylaxis if it makes your body's Ph alkaline enough to change the vibration of the ACE2 that the virus docks with. However, coupled with zinc, it should be able to prevent the virus from replicating. ET

There are 29 patients with COVID-19 at the University of Mississippi Medical Center taking part in a random trial using hydroxychloroquine, hospital leaders said. “Everybody is blind to what treatment the patients are getting, so we really have no idea exactly what the results are,” said Dr. Alan Jones, who leads the emergency department at UMMC. Jones said the hospital in Jackson is one of 30 medical facilities across the country taking part in clinical trials. Jones said UMMC received feedback this week from an outside board that monitors how the drug harms or benefits patients taking it. “The message back from that data safety monitoring board (Tuesday) was that the trial continues and that there was no reason to stop it for presumed benefit or harm at this point,” Jones said. https://www.wapt.com/article/ummc-holds-clinical-trials-using-hydroxychloroquine-to-treat-covid-19/32619423 rhampton7

Gov. Kristi Noem and Secretary of Health Kim Malsam-Rysdon said results from South Dakota’s first-in-the-nation clinical trial to determine the effectiveness of hydroxychloroquine against COVID-19 will not be available until September. Meanwhile, Malsam-Rysdon said there are two registries taking place alongside the South Dakota clinical trial. One of those registries is for people who are positive with COVID who are prescribed hydroxychloroquine by their provider. The second registry is for people who have COVID, but are not on the drug. “ We expect to have the first tranche of data from the registries in September,” Malsam-Rysdon said. “We’ll have a clinical team across the systems looking at that, seeing what we can learn about, you know, what’s maybe working better and what’s maybe not working as well for folks with COVID and, you know, hopefully, that will help us contribute to the science of this disease,” she added. https://www.capjournal.com/news/hydroxychloroquine-s-d-officials-continue-testing-drug-trump-says-he-is-taking/article_753b540a-9aec-11ea-834f-2b89ccee144d.html rhampton7

Australian researchers have started human trials of an anti-malaria drug on “high risk” health workers to test how well it can ward off coronavirus. Half of two thousand participants will be given daily doses of hydroxychloroquine while the other half will take a placebo. Researchers will monitor their health status over four months of being exposed to the virus in the workplace. https://7news.com.au/sunrise/on-the-show/hydroxychloroquine-drug-used-by-donald-trump-to-be-trialled-by-australian-health-workers-against-coronavirus-c-1050315 rhampton7

“ Wisconsin woman who’s been taking hydroxychloroquine for 19 years diagnosed with COVID-19“ I’m surprised we haven’t seen data on people like this. There are a ton of Americans taking HCQ right now for valid reasons, because they have a rheumatological condition. How many of them have gotten sick from coronavirus? That’ll give us some basic sense of whether the drug works as a prophylaxis against the disease. Eventually the partisanship around this will get so moronic that doctors won’t be able to conduct trials to see whether the drug works because politics will get in the way. People won’t want to participate. https://hotair.com/archives/allahpundit/2020/05/20/wisconsin-woman-whos-taking-hydroxychloroquine-19-years-diagnosed-covid-19/ rhampton7

The French doctors are short sighted. Months is not a concern when a vaccine is at best a year away. Then there is the very real possibility that Coronavirus could be seasonal. So when will there be a “good time” for the French doctors to do the right thing and test their treatment in an RCT? In the meantime, responsible scientists are conducting RCTs as we type (see numerous examples in previous posts) rhampton7

"There is cautious optimism that (hydroxy)chloroquine may have prophylactic and/or therapeutic effects against COVID-19, and understanding the mechanisms by which these drugs affect SARS-CoV-2 would be critical for optimizing and developing preventative and therapeutic strategies." Insights from nanomedicine into chloroquine efficacy against COVID-19 - March 2020 https://www.nature.com/articles/s41565-020-0674-9

bornagain77

Jerry, it looks like inch by inch cumulative evidence is telling. A sad story, really, as people are paying with their lives for the civilisation wide polarisation and refusal to attend to evidence that has long since been adequate. KF kairosfocus

Kf

you are again ignoring the key issues I will again bring to your attention

They are not going to read or pay attention to the issues. We know that by now. It's easy to find negative articles or someone with a contrary opinion. The evidence is overwhelming that HCQ has a positive effect with limited potential harm. It is enhanced greatly when used with zinc. We could list a hundred stories and it would have no effect. Facts and evidence will not change people's attitudes, it rarely has. This is all about one's political beliefs which are emotional. It is the one ring to rule them all for many. There is a report that the FDA has softened its recommendation on HCQ

The U.S. Food and Drug Administration said Tuesday that taking hydroxychloroquine is "ultimately" a choice between patients and their health-care providers, appearing to soften its earlier advisory against taking the anti-malaria drug outside of a hospital.

https://cnb.cx/2WN863x For those who can read French. A roundup of HCQ studies http://www.francesoir.fr/societe-science-tech/traitement-du-professeur-raoult-le-point-sur-les-connaissances-actuelles Google translation to English: https://bit.ly/2ToHd3Y jerry

RH7, you are again ignoring the key issues I will again bring to your attention:

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory.

KF kairosfocus

In the meantime, new treatments may help save lives or lessen the severity of disease in people who become ill. Researchers around the world are experimenting with more than 130 drugs to find out if any can help COVID-19 patients, according to a tracker maintained by the Milken Institute. Some of those drugs are aimed at stopping the virus, while others may help calm overactive immune responses that damage lungs and other organs. Although researchers are testing a battery of repurposed drugs and devising new ones, there is still a great deal of uncertainty over whether the drugs help, or maybe even hurt. The wait is frustrating, but there’s still much doctors and scientists don’t know about how this new coronavirus affects the body. Getting answers will take time, and finding measures to counter the virus that are both safe and effective will take even more. https://www.sciencenews.org/article/coronavirus-covid19-accelerated-vaccines-treatments-drugs rhampton7

While hydroxychloroquine is currently the subject of many clinical trials, including one in which Cleveland Clinic is participating, results are inconclusive so far. But despite the president’s comments, Cleveland Clinic experts recommend against using it. We spoke to cardiologist Steven Nissen, MD, and critical care specialist Abhijit Duggal, MD, about the drawbacks of adopting the drug. Dr. Duggal is currently part of a Cleveland Clinic team involved in an ongoing randomized control clinical trial for the drug. In these trials, some participants receive the drug but others receive a placebo and the results are judged against each other to see if the drug is impacting the patients or if there are other elements that may play a role. Dr. Nissen is also skeptical because of findings from other trials conducted on the drug and COVID-19, saying, “So far, the results of the clinical trials have not been promising. At least one study reported an increase in mortality with the drug when used to treat COVID-19 patients.” https://health.clevelandclinic.org/do-not-take-hydroxychloroquine-for-coronavirus/ rhampton7

Nebraska Gov. Pete Ricketts told a national audience Wednesday morning that he's not following the lead of President Donald Trump and taking the controversial malaria drug hydroxychloroquine in an effort to prevent a COVID-19 infection. Ricketts, an avid supporter of the president, said that he's not taking hydroxychloroquine and that the drug is not being pushed by the State of Nebraska as a preventive or a cure for COVID-19. "We have focused on the things that are proven and established through science," Ricketts told his interviewer, Washington Post national political reporter Robert Costa. https://www.omaha.com/livewellnebraska/ricketts-says-hes-not-using-hydroxychloroquine-and-that-nebraska-is-not-encouraging-its-use/article_903ebf8f-b1f3-536d-bc51-f20b1306b292.html rhampton7

You know that the French doctors did not do an RCT (and apparently are not doing one currently), That’s why, among other reasons, RCTs are done. They also establish dosage limits, treatment protocols, risks and effectiveness among subpopulations, etc. As has been explained many times the results of French study are questionable because hidden biases were not accounted for. That could very well explain the mixed results found by other studies. What will settle the matter are the results of the ongoing RCTs (34!) The fact that hydroxychloroquine is used for Lupus patients is due to RCTs that determined all the factors needed to establish a safe and demonstrably effective treatment for a prescribed set of patients. https://pubmed.ncbi.nlm.nih.gov/23144449/ rhampton7

PS: For convenience, I clip from 56 above, which has been rhetoricaly sidelined in onward comment exchanges:

Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory. <

kairosfocus

RH7, kindly address the cumulative statistics in the OP and building up over the course of a considerable time. Notice, this is from a cluster of 4 hospitals with ~ 3500 beds etc hosting a national research institute on infectious diseases headed by Dr Raoult and including about 80 research-connected people. Dr Raoult is renowned and the above is part of a pattern of findings at a major research centre. They are based on cases and show that compared to the de facto baseline there is an 80-90% cumulative reduction in fatalities, with 3000 in the IHU group and over 4000 in the baseline. It is shortly after the 80 patient stage and a linked in vitro study of effects under plausible in tissue concentrations that both France and the US issued higher level approvals, as can be tracked under the UD "Medicine" category. Whatever conditions may constrain other findings [such as administering drugs late and/or in ways that frustrate synergy of the cocktail] these are serious results that document significant effect. Other work showed rapid impact on patients as is similarly reported by others including in the OP above. Safety issues have clearly been exaggerated (it will kill you, poisoning with fish tank cleaner, the nonsense that twisted remarks into putting [raw] bleach into the body etc) and there has definitely been a combination of gold standard vs "no evidence" or near synonyms ["anecdotal"] and related ethical fallacies such as ignoring the danger of giving people sugar pills in the face of a fast acting contagious deadly disease. I am confident that ideological polarisation on this matter has severely distorted the balance on merits. It is time we took a serious reassessment of how we acted vs what could have been done and what difference could have been made. 56 above (and the onward linked) would be a good place to begin that rethinking. KF kairosfocus

Some are accusing the Democrats are denigrating this drug treatment in order to prevent Trump from being elected. There is no doubt that the US has politicized this pandemic more than any other country, but if this is a such a wonder drug, why do the experts in other countries also caution against using this drug except under closely monitored conditions? Surely this is not a global conspiracy to make Trump look bad. Ed George

Despite these concerns and the lack of evidence for its effectiveness, at least 34 clinical trials testing hydroxychloroquine for Covid-19 are currently up and running in the United States. That includes several studies that are exploring its potential as either a preexposure or postexposure prophylaxis, primarily in health care workers who are at the highest risk of exposure. Matthew Pullen, MD, an infectious disease specialist at the University of Minnesota who’s working on the hydroxychloroquine trials there, says that the drug may act as a prophylaxis by interfering with the virus’s ability to infect cells through the ACE2 receptor (a protein on the surface of cells). If the virus does get in, the medication could still prevent the virus from replicating, theoretically stopping the infection short. No results from the prophylaxis trials have been published yet to confirm whether the drug works as a preventive medication or not. Trump’s use of hydroxychloroquine also goes against the very principles of the scientific process established in the United States. The FDA specifically recommends against taking drugs that have not been proven safe or effective for use, especially if it’s not an emergency scenario. David Boulware, MD, MPH, a professor of medicine at the University of Minnesota and the lead scientist on the clinical trials, summed up the controversy in an emailed statement to Elemental, saying, “There are no data that preexposure prophylaxis is effective to prevent coronavirus. It may be. It may not be. We do not know. The only way I would recommend taking hydroxychloroquine is within a clinical trial.” https://elemental.medium.com/is-there-any-evidence-that-hydroxychloroquine-can-prevent-covid-19-d59b61bfc763 rhampton7

The responsible thing to do with a clinically untested treatment is go where the evidence follows. The president, however, has responded to the barrage of criticism with his trademark relish for a fight. He now has publicly declared that he is taking hydroxychloroquine himself, as if his personal confidence in the drug is all that matters. The president is also making a bet on a matter out of his control, and just as the evidence in support of his position is diminishing. While reports are conflicting and the jury is still out on formal trials and peer-reviewed research, the studies so far are trending against the recommendation of hydroxychloroquine. New York hospitals have abandoned it, and recent studies have found no benefit, including one conducted by the Department of Veterans Affairs. Trump dismissed the VA study, calling it “a ‘Trump enemy’ statement” and arguing that the patients given the drug “were very old, almost dead.” Donald Trump wasn’t elected for his bedside manner, but this is unworthy of the seriousness of the moment and of his office. Beware the political side effects. https://www.nationalreview.com/2020/05/the-idiotic-fight-over-hydroxychloroquine/ rhampton7

Somehow a drug has turned into a political tool. This is nuts. Hydroxychloroquine may or may not end up having any utility as a COVID drug, but its cardiac toxicity is real, unlike the nonsense surrounding it. Let's stick to the science: Torsades de pointes, not talking points. https://www.acsh.org/news/2020/05/20/real-problem-hydroxychloroquine-nothing-new-its-chemistry-14796 rhampton7

But specialists — including Dr. Anthony Fauci, the government’s top infectious disease expert — say the jury is still out on whether the drug might help prevent infection or help patients avoid hospitalization. Trump’s frequent pronouncements and misstatements — he has praised the drug as a “game changer” and a “miracle” — are only complicating matters, politicizing the drug and creating a frenzy in the news media that is impeding research. “The virus is not Democrat or Republican, and hydroxychloroquine is not Democrat or Republican, and I’m just hopeful that people would allow us to finish our scientific work,” said Dr. William O’Neill, an interventional cardiologist at Henry Ford Hospital in Detroit, who is studying hydroxychloroquine as a prophylactic in health care workers. “ The worst thing in the world that would happen,” he added, “is that at the end of this epidemic, in late September, we don’t have a cure or a preventive because we let politics interfere with the scientific process.” https://www.nytimes.com/2020/05/19/us/politics/hydroxychloroquine-trump-coronavirus.html rhampton7

are painting a different picture

Like what? Rhampton roams the net finding negative information and so far as not presented any. As far as I can see it is all positive. Remember no studies for when the patient is in serious condition and hospitalized. They are not relevant. jerry

BO'H: Raoult is not alone, but his results alone are enough. KF kairosfocus

kf - so you're going to ignore everything else? Raoult isn't God. Non-Raoult studies are painting a different picture, and whilst I wouldn't say they're definitive, they are consistent with each other, and not with Raoult. Bob O'H

Jerry @ 74 -

BTW, have you found where you got the conditions for clinical trials from that you give Jerry @ 32? Or don’t you have a reference to them?

The US Food and Drug Administration. I’m sorry I thought you would know the purpose since you champion them so much.

I thought I did, which is why your criteria seemed so strange. But if you got it from the FDA, can you point me to the document? I had looked, but couldn't find anything. Bob O'H

BO'H, Dr Raoult is a leading researcher at a first class research centre. Just on his results my summary above is well warranted. KF kairosfocus

BTW, have you found where you got the conditions for clinical trials from that you give Jerry @ 32? Or don’t you have a reference to them?

The US Food and Drug Administration. I'm sorry I thought you would know the purpose since you champion them so much. The FDA's mission is safe, effective and quality drugs. My criteria deal with safe and effective which are two of the three. Quality, which is also important, would be determined by other means. But apparently you don't understand these basics. Since safe and effectiveness are not at issue with HCQ and the alternative treatment (amelioration of symptoms) is obviously killing large numbers of people, then the use of HCQ especially with zinc poses no issues., A mechanism has been identified for why. the combination of HCQ and zinc work in eliminating the virus. So this fact makes it imperative to use them unless a superior treatment is found. Large numbers of people are now dying. I am all for finding a superior treatment. But one that has positive results and no negative results means it does not fail the safe and effective criteria. The CDC and WHO have declared HCQ safe. There is more than ample information to show HCQ is useful in fighting viral infections especially when used with zinc. Zinc is common additive available over the counter in the world. There are two stages (obviously more) which have been identified. The first is when symptoms start to appear and then progress but still the individual is functional and is not overly affected. MedCram has identified this as about 12 days after infection. Then there is a serious stage where there are a multitude of symptoms but include severe difficulty with breathing and pneumonia like symptoms. HCQ and zinc have positive results in stage 1 but their overall effectiveness in stage 2 is less effective. It is stage 1 that nearly everyone is recommending HCQ and zinc for not stage 2. However, the link you provide shows even some value in stage 2 but less than what would be expected in stage1. So results from stage 2 that show lack of positive results are irrelevant. My fault for thinking that you have some knowledge in this area but you apparently don't. Maybe you should refrain from commenting till you get more information about what is required. Your asking questions is a good first step. Glad to be of help. jerry

As at now despite your claims the pattern definitely shows some and often good effect, though earlier the better.

What? This is how they sumamrise their results:

The overall mortality was not significantly different among patients who received hydroxychloroquine compared to the control group ... Clinical worsening or lack of symptomatic improvement did not differ between patients who received hydroxychloroquine compared to those who did not ... Viral clearance, assessed by RT-PCR, did not differ significantly between the hydroxychloroquine and the control groups ... The evolution of changes on chest CT imaging was reported only in two studies; a more pronounced improvement was observed with the use of hydroxychloroquine compared to standard care ... The incidence of adverse events was significantly higher with hydroxychloroquine

So, other than a secondary end-point, there's no evidence of HCQ having a beneficial effect. I'm not sure how this translates into "shows some and often good effect", unless you only care about lungs, and not the rest of the person. Bob O'H

BO'H: As at now despite your claims the pattern definitely shows some and often good effect, though earlier the better. The real issues would be complications and when/why little effect; thus, how to tell apples from oranges or guavas from beach death apples. The sort of numbers in the OP tell a story all by themselves. KF kairosfocus

Jerry @ 64 -

It’s really messed up that no one is talking about the HCQ & zinc combination.

They are not interested in an effective treatment.

But they are. BTW, have you found where you got the conditions for clinical trials from that you give Jerry @ 32? Or don't you have a reference to them? Bob O'H

kf @ 55 -

PS: There is such a thing as cumulative evidence: in vitro studies, reasonable chemical and in vivo mechanisms, animal analogue studies, various observational and experimental studies, clinical observations, lab tests etc.

Indeed. And the piece you quote @ 56 is recommending "[h]igh quality case control studies based on thousands of cases". These sorts of studies have been done. To review what I wrote @ 44 - There’s even a review of these studies, which were summarised like this:

But rather than do these retail, here’s a review of everything in the literature on COVID-19 and hydroxychloroquine treatment up to May 13. It summarizes eleven studies (3 controlled trials and 8 observational/retrospective efforts), totaling 2354 patients receiving HCQ (alone or in combination) and 1952 controls. Overall, there was no difference in viral clearance. No difference in symptomatic improvement. No difference in overall mortality. The only clear difference between the two groups was in adverse effects, which were (on again) higher in the HCQ treated population.

Bob O'H

F/N: The framing of a narrative by rejecting qualified opinion and evidence, emphasising risks and using an already successful strawman caricature of injecting oneself with "Chlorox": here. Is this how we want to be making public policy decisions as a civilisation, given that there is a whole other side to the story? KF kairosfocus

KF, Yes, that’s an excellent way to summarize it. Thanks. How would it look if they report the EU together as they do the US? jawa

Jawa, an interesting perspective on how pandemics spread through continent scale, urbanised landmasses. KF kairosfocus

Jerry, at first, one would think your remarks just now are over the top and dismissible. Then, one recalls, we are the generation that for 40+ years has enabled the worst global holocaust in history, 800+ millions of our living posterity in the womb, currently mounting at a bit under a million per week. A toll that dwarfs what the world has locked itself down over. So, obviously we have blood guilt benumbed consciences and many institutions have had to be compromised and/or corrupted to enable such a slaughter of the innocent under false colours of law and rights. That gives pause. I suspect, most are simply swept up in polarisation and panic, so they are further not thinking straight. Known corrupt, deceitful, manipulative media are feeding obviously ill-balanced polarising narratives similar to patterns we have seen on several other topics. Politicians and celebrities are piling on, on any excuse, dissenting voices are suppressed or marginalised. In that climate of toxic polarisation and confusion, it is hard to think straight. And one doesn't doubt that there are manipulative sociopaths out there with hands on levers of influence allowing them to push agendas. Such are a given, the point is not to get into back and forth accusations, but to understand how to break out. It is clear that many major media need to be marked and set aside, and sensible voices need to be sought out. Alternatives have to be built, gaps analyses need to be made, critical masses need to be built and sound change needs to be pursued. One thing is we need to expose gold standard fallacies and other forms of selective hyperskepticism, restoring prudence. Another, is that we have to learn about the dismal choices of economics. And more. We are in a sorry state as a civilisation. KF kairosfocus

May 19, 2020 @ noon in Europe, according to JHU stats: CoViD-19 reported deaths from the start US: 90,369 Spain: 27,709 Italy: 32,007 France: 28,242 Germany: 8,041 Spain+Italy+France+Germany = 95,999 (over 5,000 more than in the US) Population (Wikipedia) US: 328 M Spain: 47 M Italy: 60 M France: 67 M Germany: 83 M Total (Spain+Italy+France+Germany) = 257 M (71 M less than in the US) The 4 largest EU countries which are geographically connected in the sense that one could go from any of those 4 countries to any of them without crossing the border to a country different than the 4. From Spain to Italy through France. From Spain to Germany through France From Italy to Germany through France. These four largest EU countries have 71 M less people than the US, but had over 5,000 more CoViD-19 deaths than the US on May 19 @ noon EU time. jawa

It’s really messed up that no one is talking about the HCQ & zinc combination.

They are not interested in an effective treatment. That would mean this would be over in two months. That would mean Trump would be reelected. Instead they want death and lots of it and disparage HCQ against all odds. They know what they are doing just as the commenters here know what they are doing. They are not that stupid but they don't care about human life, just their politics. It's sad. jerry

RH7. there are several things which have some promise; one initiative is testing 40+ existing drugs for antiviral effect. The issue is not one vs another but willingness to recognise adequate warrant, see 55 - 56 above. on vaccinations, if they work, that will be after two main waves, likely. We need reasonably rapid response that uses the warrant we have. KF kairosfocus

It's really messed up that no one is talking about the HCQ & zinc combination. This is the combo that allegedly prevents the virus from replicating. The thing with HCQ alone was that it may change your body's Ph enough to alter the vibration of the ACE2 such that covid-19 couldn't bind with it. There are other ways to change your body's Ph. The added zinc seems more promising, though. ET

Dr Merchant and his colleague Dr Hasan wrote a paper along with Dr Chia Siang Kow on the quality of the clinical trials which are administering Hydroxychloroquine. To date, they noted that there has been some evidence to suggest that the drug could be of use in serious cases of the virus. Both Dr Merchant and Dr Hasan have analysed the quality of reporting within these trials and found that many are not reporting to the standard guideline, with bias creeping into results. "I can't believe any good journal would accept a clinical trial that would publish a study without that quality criteria met. But with this condition, this pandemic, everything is so important that these quality benchmarks are not being met," Dr Merchant said. Researchers can provide a percentage mark representing the quality of a clinical trial. If the mark reaches 100%, the trial doesn't have any loopholes. However, Dr Merchant and Dr Hasan have found that the majority of trials had a score of below 50% with some dipping as low as 10%. “ What we have seen is either there are people who are supporting Hydroxychloroquine or there are people against it. The balanced approach is missing out," Dr Hasan said. "In our paper, we didn't want to take any sides". The issue is that the science is just coming to the fore. Fully-fledged studies with strong results have yet to catch up with the debate. "We don't want to discredit any beneficial effect of this drug. We don't want to take this away from humanity in this particular time of emergency when people most need it," Dr Hasan noted. https://www.euronews.com/2020/05/19/what-do-we-know-about-hydroxychloroquine-euronews-answers rhampton7

Remdesivir is a miracle cure! Remdesivir for all! To not prescribe Remdesivir is immoral! A Meriter patient was discharged in healthy condition after being treated with a recently approved COVID-19 treatment. Glenn Kindschi of Columbus was one of the first patients in Madison to be discharged after being treated with Remdesivir, a treatment that was recently approved for emergency use to combat COVID-19 infections. UnityPoint Health officials said results from a clinical trial suggests the drug may decrease the duration of an infection. Kindschi is one of more than 40 other patients who have recovered from the coronavirus at Meriter. http://fox47.com/news/local/patient-treated-with-newly-approved-covid-19-treatment-released-from-hospital rhampton7

U/D More Dr Lozano added above. kairosfocus

You’re missing the bigger picture. This virus is going to be with us at least a year before a vaccine is widely available. So we have moved from immediate triage to clinical testing in order to provide to most effective treatments for differing subpopulations based on a variety of factors. That requires repeatable, demonstrable experiments with biases removed and or accounted for. That’s why it’s the “Gold Standard” because we know how the treatment will behave for all sorts of people at different stages of the illness. That’s why every promising drug and vaccine isn’t just green lighted for general use. rhampton7

F/N: Further notice, given declarations wishing to condition full re-opening on an approved vaccine:

Scientists fear the hunt for a coronavirus vaccine will fail and we will all have to live with the 'constant threat' of COVID-19 Adam Bienkov Apr 25, 2020, 9:00 AM Some scientists fear that an effective coronavirus vaccine may prove impossible to produce. The UK's Chief Medical Officer warned on Friday that there is "concerning" evidence suggesting that people can be reinfected with the virus. He said evidence from other forms of coronavirus also suggests that immunity quickly wanes. No vaccine has ever been approved for use against previous forms of coronavirus. David Nabarro, professor of global health at Imperial College, said the world may have to learn to live with the "constant threat" of COVID-19.

Re-infection, to me, tends to suggest rapid mutation of strains [a tendency of RNA viruses like the common cold], undermining efficacy of vaccines. The only good news here is that plausibly in the longer term milder strains will prevail as they are more likely to spread than highly fatal ones. At the same time, prolonged shutdown leads to recession or even depression, which is itself a deadly albeit economic plague. We face a dismal tradeoff, aiming to minimise loss of life net, short and long term. Where as life is a quasi-infinite value, there can be no discounting of future lives lost. KF kairosfocus

F/N: Observe:

Unleash the Data on COVID-19 By Maryaline Catillon and Richard Zeckhauser* Given the lethality of the COVID-19 pandemic, the urgent need is for actionable information directing care towards treatments offering higher probabilities of improving outcomes and preventing death. In normal times, randomized control trials (RCTs) would be the gold standard for determining whether innovative medical treatments are safe and effective. But with 1,500 Americans dying every day, these are hardly normal times. There is an urgent need for high quality studies based on real world experience, which has already accumulated for many thousands of patients. Dr. Anthony Fauci, the nation’s pandemic physician in chief, said that RCT results will not be available "for months". The disease will not wait. RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met. Analyzing real world data on actual outcomes, when it exists in abundance, offers an alternative approach to learn almost immediately. Moreover, it avoids the ethical challenge of an RCT, given that available data could predict outcomes. Massive numbers of COVID-19 patients are currently being administered "unproven" drugs based on medical decisions made by doctors. Massive numbers are not receiving any such drugs. Thus, carefully designed case control studies could leverage differences between ongoing protocols at large hospital systems and detailed information from patients’ electronic medical records. That could determine whether widely employed hydroxychloroquine, with or without azithromycin, provides significant benefits, and at which stages to which patients, and could provide similar information on the risks it imposes. It could yield the same information about remdesivir, and about many other drug treatments currently in use. [--> sounds familiar? That's been a line of argument I have pointed to for weeks] For each patient, doctors strive to optimize treatment in the current, uncertain environment. These drug versus non-drug decisions constitute an ongoing large observational study, in which the allocation to treatment and control groups varies widely. The large numbers of patients treated eliminates concerns that random variation might lead to misleading results. Those large numbers also yield results by demographic, comorbidities, and stage of disease. Leveraging real world evidence is more acceptable ethically when extensive information is already available. As decision theorists who have studied the methodological quality of vast numbers of RCTs, we are enthusiasts for well-conducted RCTs. But delaying public health recommendations till RCTs are completed is not appropriate in the present circumstance. Imminent threats are enormous and widespread data is easily at hand. The outcomes of the thousands of individuals who have already received drug therapies on an ad hoc basis should inform practice now . . . . High quality case control studies based on thousands of cases, the silver standard we recommend, are immensely faster than RCTs. Recent articles in the world’s leading medical journals show that they consistently yield the same major findings. Experience with the recommendations of antiretroviral therapy (ART) for HIV provides an instructive warning. Even though 20 years of observational studies demonstrated its enormous benefits, the World Health Organization waited until 2015 and the publication of the first set of RCT results (which reached the same conclusions) to make a "treat all" recommendation. Many lives were lost as the world waited for its recommendation. COVID-19 presents its own example. Through late March, medical authorities recommended the general public not employ masks to protect against it. In early April, that all switched: masks became strongly recommended. No RCT supported this reversal; little evidence was mounted. Yet officials applauded, the public widely complied, and the world was better off.

Well conducted includes ethical criteria. Of course. But such is obviously at a discount today. And notice the by now familiar context: decision theory. KF kairosfocus

RH7, tests, trials and development, on both ethical and epistemological-inductive logic grounds, are not equal to one alleged gold standard so alleged lesser evidence can be belittled or dismissed. Such is a fallacy of imprudence, both logical and ethical. KF PS: There is such a thing as cumulative evidence: in vitro studies, reasonable chemical and in vivo mechanisms, animal analogue studies, various observational and experimental studies, clinical observations, lab tests etc. In that light, on nearly 20 years of studies, it is actually unsurprising that HCQ has some effectiveness on Corona viruses, especially in cocktails. kairosfocus

To the nay-sayers I would ask you to honestly review your personal objections. I suspect an honest assessment would show some underlying prejudices which you are unwilling to let go of. Assuming that to be the case, I am not trying to convince you to change. I am only asking for you to consider these facts for future consideration when you are finally enlightened. 1 - The perfect is your enemy in a crisis. Having worked in the fire service I know you have to deal with the emergency that is before you. There may be a "perfect way" to deal with it, but if you do not have the resources you still have to act. 2 - Exponential growth is an enemy. In the fire service we are aware of how quickly a fire grows. It literally goes from harmless to disaster in a matter of seconds. The key to success is to hit it while it is small. These doctors are hitting the virus aggressively while the person's body can still fight it off. I would note that even if you have the "regular" flu you and your family are immediately put on Tamiflu. No waiting to see if you will decline. 3 - Do a study: Remove the airbags from a car, let the person be mangled in an accident, take him to the hospital, and then pop an airbag on him as he lies dying on the stretcher. The MSM headline for that study would be "Airbags Don't Save Lives!!!!" It is a good analogy for how our medical elites have treated HCQ. Look at all the small print on our country's "studies" - HCQ given to critically ill patients. Poor results - what would you expect. HCQ (w/zinc) is expected to prevent virus duplication which allows the Average Joe to fight it off. Have a wonderful day and don't catch the virus. If you do find the doctor who will treat you and not be politically correct while you suffer. GCS

Use them all! No more clinical trials! providers are experimenting with drugs typically used to treat other conditions, Cha reports. Cha writes that one study of 1,536 Covid-19 patients showed that patients treated with a heartburn medication containing the active ingredient found in Pepcid were more likely to survive than those who weren't—though the researchers cautioned that the finding could have been coincidental. Meanwhile, Kanthi and his colleagues have been examining how some combinations of anti-inflammatory drugs and blood thinners work together to treat Covid-19, Cha reports. Separately, a study published last week in The Lancet found a combination of three antiviral drugs seemed to help patients recover from Covid-19 faster. http://www.advisory.com/daily-briefing/2020/05/19/covid-treatments rhampton7

According to the logic of some, Remdesivir should be standard for all COVID-19 patients. No further studies are needed.... Up to now, remdesivir has been a promising antiviral drug in search of a human disease. Although it is not the cure for COVID-19 that we hope for, findings from ACTT suggest that it may speed clinical recovery and those from SIMPLE suggest that 5 days of treatment is as effective as 10 days. The study from China did not show a clinical benefit of remdesivir, but the study was limited by underpowering and by the fact that the remdesivir group may have been sicker at baseline; both or either of these limitations could have affected the study such that any potential remdesivir benefit would not have been revealed. We await the complete data set from ACTT and publication of the results from SIMPLE to better understand the potential role of remdesivir in the treatment of COVID-19. https://www.infectiousdiseaseadvisor.com/home/topics/covid19/remdesivir-for-covid-19-coronavirus-severe-acute-respiratory-syndrome-coronavirus-2-sars-cov-2/ rhampton7

Most of the studies done to this point are severely limited, and there are better ones still in progress. Ideally we’d all hope for good results but not turn this life-or-death question into a ridiculous political argument, but I suppose that opportunity has already passed. The bottom line is that we need large, randomized trials with proper control groups to know what difference this drug makes. Several such studies are in the works. I don’t envy doctors who have to decide right now whether to use this drug on the patients in front of them. But if you’re not a doctor, just wait for the answer! https://www.nationalreview.com/corner/just-how-promising-is-hydroxychloroquine/ rhampton7

Randomized clinical trials—where patients are assigned randomly to two groups, one receiving a new treatment and the other receiving a placebo or reference treatment—are the gold standard for determining the safety and effectiveness of a treatment," says Andrew Lo, Ph.D., the study's senior author and the Charles E. and Susan T. Harris Professor at the MIT Sloan School of Management. "Only when the treatment group shows significant improvement over the control group, will regulators approve the therapy." He adds, "the current process is designed to protect the public by minimizing the chances of "false positives" (approving ineffective and unsafe therapies), and by and large, it's been very successful." But there is a trade-off between false positives and false negatives (not approving a safe and effective therapy), and Lo and his collaborators have developed a framework that uses an epidemiological model of COVID-19 to calculate the optimal statistical threshold for approving a drug during a pandemic. "In the midst of an outbreak, many lives are at stake so we need to be less concerned about false positives and more concerned about false negatives than during normal times," says Lo, "In response, we've developed an analytic framework that allows regulators to make this trade-off systematically, transparently, and rationally." At the core of this new framework—which was jointly developed in collaboration with MIT students Qingyang Xu and Danying Xiao, and former MIT student Shomesh Chaudhuri, Ph.D. (now at QLS Advisors)—is an explicit optimization algorithm designed to minimize the expected loss of life across various scenarios generated by a statistical model of an infectious disease. This algorithm, says Xu, will lead to more drug approvals during outbreaks, not unlike the U.S. Food and Drug Administration's Emergency Use Authorizations (EUA) program. "Our framework complements the EUA, allowing regulators to incorporate loss-of-life considerations quantitatively during periods of extraordinary stress," explains Xu, the lead investigator of the study. https://medicalxpress.com/news/2020-05-statistical-approach-covid-clinical-trials.html rhampton7

Rep. Roger Marshall (R-Kan.) revealed that he and his entire family are taking the anti-malarial drug hydroxychloroquine “prophylactically” to ward off the coronavirus despite limited evidence from the medical community. Marshall, an obstetrician who is running in the state's heated Republican primary for an open Senate seat, told The Wall Street Journal that he was “relieved” to hear President Trump has also decided to take the drug as a preventative measure. https://thehill.com/homenews/house/498569-gop-lawmaker-says-his-entire-family-is-taking-hydroxychloroquine-to-ward-off rhampton7

Why not use all the drugs and vaccines that seem promising without going through the clinical trials? Why limit this policy to just COVID-19? Lets’s throw everything we can at Cancer and damn the Science! rhampton7

There is no issue that this treatment has harmful effects. So why do the study? There is plenty of evidence that the treatment has benefits.

Plenty of bad evidence. But the better evidence that I linked to says there's little to no benefit, and there are harmful effects. This is evidence that's accumulating from several studies in several countries. It may be the RCTs will give a different story, but until then what good evidence is there that HCQ has an effect? Where are the case-control studies?

Why don’t you propose a study design?

Because I don't have any expertise in clinical medicine. Bob O'H

why the commentary you link to @ 37 repeatedly say high quality case-control studies should be done.

This is becoming a joke. There is no alternative treatment. There is no issue that this treatment has harmful effects. So why do the study? There is plenty of evidence that the treatment has benefits. The question is whether it works on all the patients or just on part of the patients. No one is pushing hard on using it for really sick patients. Only the FDA and some other health agencies are doing that and their reasoning is specious. Why don't you propose a study design? I am sure you will punt. jerry

Jerry @ 39 -

From article:

In Marseille with the HCQ + AZ protocol and screening, the rate is 30 times lower than in the whole of France

Maybe a statistician could make sense of that to see if it is significant. Sounds to me like a lot less dead people in Marseille. Maybe it is because a doctor cares.

That sort of ecological study is fraught with all sorts of problems. One is that the difference in mortality might be because of the increased testing. or it might be that the HCQ patients differ in other ways from non-HCQ patients (e.g. sicker patients don't get HCQ). Without more information it's difficult to know, which is why the commentary you link to @ 37 repeatedly say high quality case-control studies should be done. Bob O'H

Jerry @ 37 -

You should read more. You apparently do not understand what RCTs are for. You have been provided with information in recent posts on your irrational insistence for a RCT. I suggest you read the following about the use of RCT’s. https://bit.ly/3bRxuuo

They don't give the conditions you stated @ 32. So, I'll ask again - where do you get those conditions from?

Since there is no question that the drug has some effectiveness

In the real world, there is a huge question over the effectiveness of HCQ. FWIW, the commentary you linked to argues for high-quality case control studies. These are already being done and publshed, e.g. the VA study, and the French study I linked to @ 38. There's even a review of these studies, which were summarised like this:

But rather than do these retail, here’s a review of everything in the literature on COVID-19 and hydroxychloroquine treatment up to May 13. It summarizes eleven studies (3 controlled trials and 8 observational/retrospective efforts), totaling 2354 patients receiving HCQ (alone or in combination) and 1952 controls. Overall, there was no difference in viral clearance. No difference in symptomatic improvement. No difference in overall mortality. The only clear difference between the two groups was in adverse effects, which were (on again) higher in the HCQ treated population.

Bob O'H

BO'H: The results, linked, as at yesterday are in the OP. They are decisive, as are many others. And yes, there is reasonable inductive warrant for effectiveness despite your dismissiveness. As Jerry, the undersigned and others have pointed out, there are ethical questions relevant to placebo based designs. We need to recognise good enough warrant. KF kairosfocus

I still say we give Bob the disease in its most virulent form and see how he acts then. Nothing like the real world consequences of their ideas to their personal lives to humble those who live up in ivory towers high above those smelly Walmart shoppers. :) bornagain77

awstar - I don't understand. Test what both ways? Bob O'H

kf @ 34 -

BO’H: The issue is not persuasion but reasonable inductive warrant.

So you don't mind if an effective drug isn't used, as long as there is a "reasonable inductive warrant"? What a strange idea.

Accordingly, I contend that the problem of imposing an ethically questionable gold standard and rejection of reasonable warrant reflects the gross errors of our age in devaluing life and in substituting the intellectual vice of selective hyperskepticism for the virtue of prudence.

You can, of course, contend that. But it doesn't help persuade people now that HCQ is an effective treatment for COVID-19. Bob O'H

No effect on survival, and 10% of those treated with HCQ had to dis-continue because of side effects.

Why don't you comment on the link above in #3 about recent results in France. Apparently there are big differences between areas of France and PACA leads the list and Marseille is the best. If you do not speak French, Google will translate it for you. From article:

In Marseille with the HCQ + AZ protocol and screening, the rate is 30 times lower than in the whole of France

Maybe a statistician could make sense of that to see if it is significant. Sounds to me like a lot less dead people in Marseille. Maybe it is because a doctor cares. jerry

kf @ 24 -

PS: Kindly notice the onward results in France.

Do you mean this paper? No effect on survival, and 10% of those treated with HCQ had to dis-continue because of side effects. It's another retrospective study, so certainly isn't definitive. Bob O'H

where do you get those conditions from? I’ve never seen them as conditions for clinical trials, or anything close to them.

You should read more. You apparently do not understand what RCTs are for. You have been provided with information in recent posts on your irrational insistence for a RCT. I suggest you read the following about the use of RCT's. https://bit.ly/3bRxuuo Here is a quote from it.

RCTs, which randomly assign patients to a treatment or a control group, are only ethically acceptable when the safety and performance of a treatment is unknown. When ample data exists, as now, that criterion is not met.

You may think that it’s meaningless if a drug is effective against COVID-19, but I’d beg to differ.

Since there is no question that the drug has some effectiveness and probably a lot in this situation are you saying that people dying should not be a concern? jerry

Jerry @ 32 - where do you get those conditions from? I've never seen them as conditions for clinical trials, or anything close to them. Jerry @34 -

Maybe Raoult doesn’t want people to die to prove a meaningless point.

You may think that it's meaningless if a drug is effective against COVID-19, but I'd beg to differ. Bob O'H

BO'H @ 23

If HCQ works, then more live could be saved by showing that it does work. If he ran a proper trial which showed it was effective, a lot more doctors would use it as a treatment.

Why not test it both ways. What do you have to lose? awstar

BO'H: The issue is not persuasion but reasonable inductive warrant. The steady progress of results for Dr Raoult alone, from was it 24 to now just under 3300 is enough to show that by comparison with near-Flu + Complications etc, there is a reduction in death rates that may be in a range 80 - 90+% once treatment with the HCQ cocktail is prompt. This is consistent with other clinical reports from around the world and the various levels of approvals. In addition, ALL drugs are inherently dangerous (even sugar, salt, Carrot juice and water) -- pharmacology is the study of poisons in small doses -- but despite much headlining and emphasis on potential risks, there is strong report from professionals and authorities that relevant components are reasonably manageable. Moreover, proof is not in the gift of inductive methods, only reasonable warrant i/l/o prudence. Accordingly, I contend that the problem of imposing an ethically questionable gold standard and rejection of reasonable warrant reflects the gross errors of our age in devaluing life and in substituting the intellectual vice of selective hyperskepticism for the virtue of prudence. These last are far broader than this subject . . . consider the ongoing holocaust of living posterity in the womb at a bit under a million further victims per week . . . but they also manifest themselves on this subject. Accordingly, serious reform is indicated. KF kairosfocus

Raoult doing the work to try to convince them? He knows what the established standards are, and what to do.

Maybe Raoult doesn’t want people to die to prove a meaningless point. A very admirable position that seems to be lacking in many others. jerry

You didn’t read carefully. Try it again, slowly.

Oh, I read very carefully. But you unwittingly made the case for HCQ immediate use. Ask yourself the question how many lives could have been saved if it was prescribed 2 months ago when they first knew about it and these studies were started. My guess way over 200,000. The case for a RCT only makes sense if there are two conditions met. First, there is already a known effective treatment and you want to improve on it. In this case there is no known alternative treatment. So no need for a RCT. Second, if the proposed treatment has potential harmful effects that would offset the benefits of the treatment. In this case no harmful effects exist. So no need for a RCT. Now you can see how you made the case for HCQ+. Read carefully! Thank you!!! jerry

kf @ 24 & Jerry @ 26 - yes, yes, you are convinced by the evidence on HCQ, but many others aren't. So why isn't Raoult doing the work to try to convince them? He knows what the established standards are, and what to do. And he's already seen enough patients to have a reasonable sample size. So why hasn't he tried to give the medical community the evidence it wants? Bob O'H

You didn’t read carefully. Try it again, slowly. rhampton7

RHampton has just provided great evidence on why we should move forward immediately with HCQ, azithromycin and zinc. He links to two studies and essentially is justifying using these drugs for C19. These studies take months to complete and meanwhile over 90.000 are dead in the US since these studies first started. But we have reports of nearly 0% death with HCQ in conjunction with some other drugs when used early in infection. Probably could have saved 300,000 dead in world if these treatments started two months ago. Thank you RHampton for making the case for HCQ+. We could have solved the problem with food supply too. Wow!!! jerry

Henry Ford Health System in Detroit issued a press release defending its major clinical study of the drug with hospital employees, first responders, including police and firefighters, and bus drivers. The ages range from 18-75. "We are not involved in politics; we are scientists,” said Dr. William O’Neill, a prominent cardiologist at Ford who heads the clincal study. “There are no proven ways to keep people safe from Covid-19." "This is a drug that has been used safely for more than 70 years to prevent malaria and treat other issues like lupus, with the potential to have active effect on Covid-19. We owe it to people – particularly front-line workers – to scientifically determine if it works.” The Ford study, announced at a Detroit press conference in early April, involves giving people different doses while giving others a placebo. Henry Ford Health System participates in Covid clinical trials around the world. More than 25 studies are underway or being reviewed at the Detroit-based network to treat or prevent COVID-19. https://www.deadlinedetroit.com/articles/25291/detroit_s_ford_hospital_defends_hydroxychloroquine_study_after_trump_s_disclosure rhampton7

The trial marks a highly visible departure from the double-blind, placebo-controlled randomized clinical trials that have ruled medical science for most of the last four decades. Often called RCTs, they’ve allowed researchers to assess the safety and effectiveness of drugs before they reach American patients. To identify the most effective COVID-19 drugs at top speed, the National Institutes of Health have embraced an approach called the adaptive clinical trial. The Adaptive COVID-19 Treatment Trial, better known to medical researchers as ACTT, has been hailed as a fast, flexible and relatively cheap way to sort through an array of drugs and provide doctors with standard treatment protocols for their patients. Sometimes called “learn as you go” trials, they accelerate the testing process by allowing early results to dictate changes in a trial’s objectives, its participant pool and even the standards of comparison it uses. By slashing through regulatory strictures built up over decades, it has given Fauci a rare bit of common ground with President Donald Trump. ACTT enrolled its first subject on Feb. 25 at the University of Nebraska. The trial, sponsored by the National Institutes of Health, now has 800 participants in 39 sites across the country, and several sites abroad. It was originally designed to test hydroxychloroquine, but after early studies cast doubt on the malaria drug’s safety and effectiveness, researchers switched to remdesivir. http://tribunecontentagency.com/ rhampton7

If he ran a proper trial which showed it was effective, a lot more doctors would use it as a treatment.

Apparently the good doctor in Marseille knows statistics. He can compare 0.5% with 8.6% and see the difference (actually believe rate for all of France is higher). He is most likely using probability to estimate the dead that would exist if no action was taken till the proper trial was done. Maybe he cares more about human life than most to know that doing a study before acting is insanity or essentially inhuman or heartless. Actually a lot of trials are going on but all the press reports on is the irrelevant hospital surveys of critically ill patients. That is part of the real crisis, not whether some doctor wants to save lives and has an effective treatment to do so. And then. there is Google censoring information about zinc. If there ever should be an outrage, that is where one should be focused. See comment above about RCT. On cue jerry

AWS, you have a point. KF kairosfocus

BO'H, gold standard fallacy in the teeth of adequate inductive, empirical warrant that shows efficacy over and above the de facto standard treatments. In fact, placebo control double blind tests etc are known to face ethical challenges which make them inappropriate in many cases. One of those is, risk of harm in the face of a fast moving fatal pandemic disease that can kill in days. Such issues have already been discussed here at UD. The implication of your phrasing is that in fact epistemologically and inductively adequate warrant is improperly dismissed as it does not meet a demanded gold standard; one which is ethically challenged. KF PS: Kindly notice the onward results in France. kairosfocus

Why won’t the French doctors do the same clinical trial? There is no good reason not to.

How about saving lives as a reason not to?

If HCQ works, then more live could be saved by showing that it does work. If he ran a proper trial which showed it was effective, a lot more doctors would use it as a treatment. Bob O'H

Jerry @ 19

Why won’t the French doctors do the same clinical trial? There is no good reason not to.

How about saving lives as a reason not to? When you are interested in saving lives and you are having almost 100% success, one knows that a control test will kill innocent people. But if you don’t really care about people’s lives, you do a control test which takes months.

I think Jerry just gave us a working definition of an MD (Doctor of Medicine) and a PHD (Doctor of Philosophy) awstar

Truth to power . . . ? kairosfocus

Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.

MedCram did an analysis of this study on Sunday. Google took down the YouTube video by Monday. They have taken down most of the Zelenko videos. Interesting that in all the searching of the internet to find gloomy news, people can not find positive information or the censorship going on. It is so easy to find. jerry

Why won’t the French doctors do the same clinical trial? There is no good reason not to.

How about saving lives as a reason not to? When you are interested in saving lives and you are having almost 100% success, one knows that a control test will kill innocent people. But if you don’t really care about people’s lives, you do a control test which takes months. As I commented above, wait for the RCT objection to pop up and on cue. jerry

F/N: Meanwhile, there are indications that the 135 bed TX Nursing Home case has worked out well, despite early alarmism and after the fact persistent fears. KF kairosfocus

F/N: Early Zn results, in a preprint:

https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1 Abstract Background: COVID-19 has rapidly emerged as a pandemic infection that has caused significant mortality and economic losses. Potential therapies and means of prophylaxis against COVID-19 are urgently needed to combat this novel infection. As a result of in vitro evidence suggesting zinc sulfate may be efficacious against COVID-19, our hospitals began using zinc sulfate as add-on therapy to hydroxychloroquine and azithromycin. We performed a retrospective observational study to compare hospital outcomes among patients who received hydroxychloroquine and azithromycin plus zinc versus hydroxychloroquine and azithromycin alone. Methods: Data was collected from electronic medical records for all patients being treated with admission dates ranging from March 2, 2020 through April 5, 2020. Initial clinical characteristics on presentation, medications given during the hospitalization, and hospital outcomes were recorded. Patients in the study were excluded if they were treated with other investigational medications. Results: The addition of zinc sulfate did not impact the length of hospitalization, duration of ventilation, or ICU duration. In univariate analyses, zinc sulfate increased the frequency of patients being discharged home, and decreased the need for ventilation, admission to the ICU, and mortality or transfer to hospice for patients who were never admitted to the ICU. After adjusting for the time at which zinc sulfate was added to our protocol, an increased frequency of being discharged home (OR 1.53, 95% CI 1.12-2.09) reduction in mortality or transfer to hospice remained significant (OR 0.449, 95% CI 0.271-0.744). Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.

Worth noting. KF kairosfocus

Vivid, he has obviously been seriously misled regarding risks. KF PS: The exchange:

Cavuto: Dr. Janette Nesheiwat with us right now. Doctor, what do you think of this — surprised a lot of folks, the president wanted to take hydroxychloroquine, the White House physician or physician team let him, as a preventative measure I guess, to ward off COVID-19. Do you agree with hydroxychloroquine for that use? Dr. Nesheiwat: Hi, Neil. So it’s important to understand, first and foremost, this is an FDA-approved drug. It is not new, it’s been around for many years, and he is taking it as a prophylactic, preventative measure, which I think is very smart to do, because, you know, there’s a lot of people, we just saw recently the vice president’s press secretary tested positive. And you never know, with people coming and going, even if you test daily, you could pick it up, you know, that evening, and then potentially spread it, you know, the next day or two. [--> key context] Cavuto: Would you recommend it, doctor? Doctor, Would you recommend it? Would you recommend it, someone who, a patient came to you, “Doctor, I just heard the President of the United States is taking this as a preventative measure for COVID-19, I want to do it, too. Would you write a prescription for that patient to do just that? Dr. Nesheiwat: Neil, being a doctor on the front lines of this pandemic here in New York City, I have prescribed hydroxychloroquine to some of my patients. And for some of them, they said it helped tremendously. Some of them, it didn’t make much of a change. But each person needs to be looked at individually — Cavuto: For COVID-19? COVID-19, to deal with it — not for malaria, lupus, but for COVID-19 — you were fine with that? Dr. Nesheiwat: Yes, absolutely. For COVID-19. I have prescribed it to patients who were very, very ill. Some of them benefited from it. Some of them did not. So we need to look at each patient individually. You have to talk to your doctor. We have to look and see, do you have any underlying medical problems? Do you have post-follow-up? Will this medicine interact with any other medicines you may be on? So we have to look at the situation individually — Cavuto: Well, I just had a doctor on — I just had a doctor on, just to be clear, and I want to make sure I’m sharing good advice with people at home — that if you had any respiratory issues, cardio-related issues, diabetes, or any — this is not the thing you want to be taking. Is — I had a prior physician on earlier, who was saying, under no circumstances would I allow that. What do you think? Dr. Nesheiwat: That’s not necessarily true. We have to look at the individual medical history, their past medical history. Now, if you have an underlying cardiac arrhythmia, we ned to be careful. We might not want to put you on that unless, you know, you’re on your deathbed and it’s the last resort. But again, what’s important is that you look at the patient’s history, their underlying status, what medicines are they on, do they have any underlying medical problems. This is not a medication for everyone. But it’s important to have that conversation with your doctor to decide: is it best for you? Are you in a high-risk category of death from coronavirus — or, maybe you’re better off just taking high-dose zinc and vitamin D, for example. Both have been show to help fight coronavirus and help prevent viral replication. Cavuto: Got it. So if you’re in any of that high-risk group, if you’re in any of that high-risk group — very quickly, doctor — that might have any of these other issues, because there are many right now who might, and are hearing the president say that i’s a good thing to do — are you saying that, that group, the one thing you could lose is your life. You’ve got to be very careful, or not? Dr. Nesheiwat: It’s something that you can consider — again, you’ve got to have to have the discussion with your doctor to decide if it is best for you. It’s not going to be good for everyone. But it may be beneficial, and potentially life-saving for others. So think it is good to have this medication in our toolbox, along with remdesivir, while we wait for vaccines to become approved, and for other therapeutics to get on the market. Cavuto: All right, doctor. All right, we will have more after this. Dr. Nesheiwat, thank you very much.

PPS: It clips earlier remarks: >>Earlier in the program, Cavuto spoke with Dr. Robert Lahita, a prominent physican in New York, who said that while “we use it in those who are very sick,” he had seen “no effect whatsoever.”>> --> By then, it is onward complications that may well be doing the final damage: too late to do any good vs a stitch in time saves nine. I have seen reports that by that time, viruses may actually be absent. The VA tests were seriously flawed in this regard and were reported in misleading ways. kairosfocus

F/N:Notice the Raoult numbers as they keep on mounting up; 0.52% vs 3.13% fatalities. 80 - 90% reduction in deaths relative to the de facto standard, seems plausible. KF PS: While I have serious questions on ethics of placebo studies in this context [time, exposure to danger etc], the very fact that HCQ cocktails are being brought to such tests says something. I think we need to rethink the gold standard approach, given the general nature of inductive reasoning, patterns of evidence that are already available and the issues tied to first do no harm. kairosfocus

“If you are in a risky population here, and you are taking this as a preventative treatment to ward off the virus, or in a worse-case scenario you are dealing with the virus and you are in this vulnerable population, it will kill you,” the “Your World with Neil Cavuto” host said. “ I like Cavuto but what evidence does he have for this statement when prescribed under a Drs care? What does he mean by “ risky population” Vivid vividbleau

Then there is this https://www.breitbart.com/the-media/2020/05/18/neil-cavuto-shocked-by-doctor-who-calls-hydroxychloroquine-potentially-life-saving/ Vivid vividbleau

A clinical trial has begun to evaluate whether the malaria drug hydroxychloroquine, given together with the antibiotic azithromycin, can prevent hospitalization and death from coronavirus disease 2019 (COVID-19). The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is sponsoring the trial, which is being conducted by the NIAID-funded AIDS Clinical Trials Group (ACTG). Teva Pharmaceuticals is donating medications for the study. The Phase 2b trial will enroll approximately 2,000 adults at participating ACTG sites(link is external) across the United States. Study participants must have confirmed infection with SARS-CoV-2, the virus that causes COVID-19, and be experiencing fever, cough and/or shortness of breath. The investigators anticipate that many of those enrolled will be 60 years of age or older or have a comorbidity associated with developing serious complications from COVID-19, such as cardiovascular disease or diabetes. Participants will be randomly assigned to receive short-term treatment with either hydroxychloroquine and azithromycin or matching placebos. People living with HIV and pregnant and breastfeeding women also are eligible to participate in the study. The first participant enrolled today in San Diego, California. https://www.nih.gov/news-events/news-releases/nih-begins-clinical-trial-hydroxychloroquine-azithromycin-treat-covid-19 Why won’t the French doctors do the same clinical trial? There is no good reason not to. rhampton7

Fox News's Neil Cavuto warned that people must be careful with hydroxychloroquine. “The fact of the matter is though, when the president said 'what have you got to lose?', in a number of studies, those certain vulnerable population has one thing to lose: their lives," Cavuto said.  "If you are in a risky population here, and you are taking this as a preventative treatment to ward off the virus, or in a worse-case scenario you are dealing with the virus and you are in this vulnerable population, it will kill you," the "Your World with Neil Cavuto" host said.  “I cannot stress enough. This will kill you. So, again, whatever benefits the president says this has, and certainly it has had for those suffering from malaria, dealing with lupus, this is a leap that should not be taken casually by those watching from home or assuming, well the president of the United States says it's OK," he said. Cavuto said he was not seeking to get involved in a political debate with his own comments.  "I only make this not to make a political point here but a life and death point. Be very, very careful," he said.  https://thehill.com/homenews/media/498400-fox-news-cavuto-warns-hydroxychloroquine-will-kill-you-after-trump-announces?amp rhampton7

Fox News Channel senior managing editor for health news Dr. Manny Alvarez said Monday that President Trump was being "highly irresponsible" for taking the antimalarial drug hydroxychloroquine as a preventive against contracting coronavirus. "I found it to be highly irresponsible for the president to have come out and make that statement," Alvarez told "Special Report with Bret Baier." "And I would like to hear from the White House physician, to come out tomorrow and explain to me what has changed in a week and a half or two weeks for the president to take this medication when all the data that has been coming out, you know, very repetitively has shown that there's really not a major benefit in most hospitals, including mine." Alvarez explained there are currently no case review studies showing the drug to be "effective" and warned about side effects. https://www.foxnews.com/media/dr-manny-trump-highly-irresponsible-hydroxychloroquine-coronavirus rhampton7

complaining on Mr Trump giving a rough NY Contractor layman rendering on F-35 stealth technology is irrelevant to several troubling concerns being put on the table

If there was a legitimate objection, it would be put on the table for evaluation. Those who argue against HCQ especially with zinc are an example of the "dog barking in the night." They are literally not barking because there is nothing to bark at. Thus, irrelevant diversion is the best they can offer. Each attempt is actually an endorsement of the treatment so we should thank those who do it. I am waiting for the "there is no RCT" objection. The Brazilian doctor's reference list linked to above includes use of HCQ for viral infections that date to the 1980's, jerry

Seversky, I suggest you listen to the full statement of the Doctor (who dates back to the early HIV days) and to her summary of her experiences with her patients. She explicitly stands on her own informed judgement as a physician and summarises significant initial relief in ~ 5 hrs, getting major symptoms under control in 24 - 48 hrs and more. She points to a fear factor that apparently amplifies suffering. Patients are being sent home by facilities with little treatment, are told isolate. and as a result she is seeing families with multiple patients. There is a further issue of pharmacies being given instructions to demand diagnoses and resisting issuing prescriptions. Distractive cross-complaining on Mr Trump giving a rough NY Contractor layman rendering on F-35 stealth technology is irrelevant to several troubling concerns being put on the table. Meanwhile, the Raoult numbers keep on marching on the same line. KF kairosfocus

Then there is this Cedar Sinai Dr Daniel Wallace author of over 400 peer review papers wrote “ HCQ is very safe drug, in over 42 years of practice no patient of his has ever been hospitalized for HCQ complication” I don’t know if HCQ is effective against Covid but to say it’s an unsafe drug when prescribed under a Drs care is ludicrous. Vivid vividbleau

Anyone who relies on Donald Trump for medical advice or any kind of technical advice is playing Russian roulette with their health. This is the man who boasted to US Coast Guard pilots that the F-35 fighter was equipped with something like a Romulan cloaking-device that makes the aircraft completely invisible in flight. He simply doesn't care about whether what he says is true or false. All he's concerned about is whether it makes the right impression on his audience at any given moment. And you are going to take his word on anything? Good luck with that. As for self-proclaimed pro-Trump activist, Dr Lozano, taking to the streets with a loud-hailer is not how you do science or medicine, although it's a good political stunt. Seversky

Fun stuff, u/d, what happened when prescriptions reach the pharmacy. kairosfocus

I saved this vid, too. My guess is, gone in 24 - 48 hours. kairosfocus

Several of Zelenko's videos have been taken down. It is called violating community guidelines. My guess is that the community guidelines are letting people die from ignorance. I have already made a copy of this video in. case it gets taken down. I wish I had done that with the other Zelenko videos. I do have a few though. Brazilian infectious disease doctor has posted a list of successful studies using HCQ. https://bit.ly/2ZfQAGX and https://bit.ly/3cVsw0d Some go back to the 1980's In France where the rate of death is very high, it is very low in Marseille which uses Raoult formula. https://bit.ly/36aei93 (may be in French but here is key passage in English)

When we now look at the treatments used and here the data are at the level of the city of Marseille. The mortality rate, all positive people, all hospitals combined, is 3.1%. This rate rises to 8.6% for people who have not received the HCQ and AZ treatment. What is interesting to note is that this rate is 0.5% for patients who have received HCQ and AZ treatment.

jerry

Anybody making bets as to how long before this video is suppressed by YouTube/Google? kairosfocus

Doctor Ivette Lozano from Dallas, Texas on treating patients with HCQ Cocktails -- also, Mr Trump praises a promising vaccination and reveals he is on the HCQ cocktail. With Dr Raoult's latest numbers. Whose report do you believe, why? kairosfocus