Hydroxychloroquine wars, 6: Dr Zelenko’s interview with Rudy Giuliani

_{kairosfocus

March 31, 2020

Academic Freedom, Defending our Civilization, Medicine, News Highlights, rhetoric, Sci-Tech watch}

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Jerry, see my just above on the switcheroo where "skepticism" has been put up in substitution for prudence, leading to severe breakdown of soundness in decision-making and epistemology. KFkairosfocus_{April 2, 2020
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Anyone with the current information who argues against the use of Hydroxychloroquine and zinc or something shown equally equivalent is essentially sentencing large numbers of people to death. The overall problem is obviously bigger than this. Everyone has to get this disease either through exposure or a vaccine. But the path to that is precarious. That is why the testing for the disease or the anti bodies in the blood is essential. People have to go back to a normal way of life or we will see chaos like the world has never seen in centuries.jerry_{April 2, 2020
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Thanks and a HT to Jerry. Thanks and HT to kairosfocus.ET_{April 2, 2020
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DS, kindly see just above. KFkairosfocus_{April 2, 2020
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I take 45-60mg of zinc a day. 45 minimum and up to 60 if I am feeling sick. 30 comes in a ZMA stack- zinc aspartate, zinc mono-L-methionine and magnesium, with B-6 added. The rest comes from zinc lozenges to coat my throat.ET_{April 2, 2020
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@47 Kairosfocus:
Yes, it is always possible that what we imagine are causal effects are accidents
Bacteria to dinosaurs gradualist non-sense fits here. Darwin (who was NOT very original, more like a plagiarist) saw what breeders had been doing for centuries and tried to apply it to 'nature'. And gullible people were on his side.Truthfreedom_{April 2, 2020
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JT, skepticism, contrary to many current ideas, is NOT an intellectual virtue, especially in the form, selective hyperskepticism. What is a virtue, instead, is prudence. Let me cite McManaman, with general approval but not necessarily complete endorsement:
[I]t is prudence that determines the mean of reason in all human actions and situations. Prudence, however, is not merely an intellectual virtue; it is also a moral virtue. A moral virtue is a habit that makes its possessor good. One may be brilliant and learned without being morally good, but it is not possible to be prudent and not morally good. The prudent man is one who does the good, as opposed to one who merely knows the good . . . . [T]heories are normally revised in the physical sciences; for the objects of mathematics are more abstracted from matter than are the objects of the science of biology. Similarly, we enjoy a relatively high level of certainty when dealing with very general moral issues such as murder, euthanasia, lying, etc, but as we approach the level of the particular, that is, a more concrete level, we very often become less certain about what we ought to do, because the concrete level contains so many variables that render decision making much more complex; for there is much more to consider [--> and we are oh so prone to error and/or ill-will]. This does not mean that there is no truth on the concrete level of moral decision making, or that on this level the moral good is merely relative (i.e., relative to how you feel or what you want). Nothing could be further from the truth. Rather, it means that a special virtue is required by which one might see and readily make one's way through these murky waters to the right end. Prudence [then] is the application of universal principles to particular situations, and so an understanding of universal moral principles is absolutely necessary. But since prudence deals in particulars, in the here and now of real situations, a number of other intellectual qualities are also necessary if one is to choose rightly, qualities that one does not necessarily acquire in a classroom setting. St. Thomas refers to these as integral parts of prudence, without which there is no prudence, just as there is no house without a roof, walls, and a foundation . . .
By switching the intellectual focus to the primacy of doubt over claims of warrant, a grave and damaging error has been made by our civilisation's intellectual leaders over several centuries. That error has now become embedded in education and popular culture, leading to damaged ability to soundly, prudently warrant and decide aright. By contrast, in epistemology and the context of inductive logic applied to empirical observations, a better understanding informed by first duties of reason including prudence, leads to the concept of graded warrant. Mix in, the complex challenges of decision-making and praxis with a life-threatening crisis and we further face the concept of moral responsibility to conclude and act appropriately in good time, without undue delay or postponement tantamount to incremental refusal to do the right. Here, we see the issue of warrant to moral certainty such that one is irresponsible to act as if X were false on accessible evidence and reason pointing to its truth. Especially, in a context of cumulative, growing evidence that takes time to emerge in the face of a crisis where infection and linked death rates can double every two to three days due to quasi-exponential growth. Ideally, on the strength of in vitro evidence and HCQ's base of evidence and experience as a clinical drug, multiplied by the pressing need for broad spectrum antivirals, studies on clinical efficacy, cocktails etc should have been done starting at least c 2005. By that time we saw the threat of SARS and had in hand published data on the promise of CQ and its relative HCQ. So, our first admission of failure is that we did not act in good time. A linked issue is that given generic status and the cost of trials, it would likely have been a financial loss to go through the complexity and cost of a trials and approvals process. (Notice, back in the 50's, CQ's action on arthritis etc was noted clinically and use of the drug for this seemed to grow from that. HCQ was brought in to reduce toxicity.) That brings in a second failure point, excessive bureaucratisation that apparently makes it difficult to explore and obtain certification of potential extended uses of existing drugs with known patterns and problems. Off label prescription comes across as an ad hoc patch in that context. The themes of where bureaucracy goes are well known. Now, we come to the specific case. By late Feb, enough was on the table for Bahrain to act. There was evidence of good promise. This was actually being more or less favourably tracked in the media. But, so soon as Mr Trump -- in a context of actual FDA initial approval for compassionate, emergency use on March 19 -- dared to suggest this as a point of hope, coverage instantly turned sharply hostile, dismissive and alarmist. The case of the people poisoning themselves with fish tank cleaner (I gather, the couple each swallowed a teaspoonful . . .) and its coverage is emblematic. This led to a wave of bans by state Governors, right on the eve of Raoult's release of his second clinical study of 80 patients backed up by in vitro studies at plausible concentrations. I ask, what are the odds of fast acting success typically on order of 5+ days, for 78 of 80 patients, by simple chance? Let me cite from my earlier OP:
Our two articles published this evening help to demonstrate: 1. The effectiveness of our protocol, on 80 patients. 2. The relevance of the association of hydroxychloroquine and azithromycin, thanks to research carried out in our P3 containment laboratory. https://t.co/Y91bsFOgB2 – Didier Raoult (@raoult_didier) March 27, 2020 . . . . New article published online by my teams: in vitro demonstration of the hydroxychloroquine / azithromycin synergy to counter the replication of SARS-COV2 In vitro testing of Hydroxychloroquine and Azithromycin on SARS-CoV-2 shows synergistic effecthttps: //t.co/KUaag6N5FF – Didier Raoult (@raoult_didier) March 27, 2020 . . . . Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study Running title: Hydroxychloroquine-Azithromycin and COVID-19 Abstract We need an effective treatment to cure COVID-19 patients and to decrease the virus carriage duration. In 80 in-patients receiving a combination of hydroxychloroquine and azithromycin we noted a clinical improvement in all but one 86 year-old patient who died, and one 74 year- old patient still in intensive care unit. A rapid fall of nasopharyngeal viral load tested by qPCR was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% patients at Day5. This allowed patients to rapidly de discharge from highly contagious wards with a mean length of stay of five days. We believe other teams should urgently evaluate this cost-effective therapeutic strategy, to both avoid the spread of the disease and treat patients as soon as possible before severe respiratory irreversible complications take hold . . . . In vitro testing of Hydroxychloroquine and Azithromycin on SARS-CoV-2 shows synergistic effect Abstract Human coronaviruses SARS-CoV-2 appeared at the end of 2019 and led to a pandemic with high morbidity and mortality. As there are currently no effective drugs targeting this virus, drug repurposing represents a short-term strategy to treat millions of infected patients at low costs. Hydroxychloroquine showed an antiviral effect in vitro. In vivo it also showed efficacy, especially when combined with azithromycin in a preliminary clinical trial. Here we demonstrate that the combination of hydroxychloroquine and azithromycin has a synergistic effect in vitro on SARS-CoV-2 at concentrations compatible with that obtained in human lung.
Prudence, i/l/o the value of human life, would manifestly support initial, provisional use of the drug for treatment to prevent fatal complications for the at-risk, and for prophylaxis for health care workers on the frontlines, who obviously have higher exposure. In short, we do not have the luxury to act at leisure here. That opportunity, due to our structural institutional errors, was lost over a decade ago. Now, with SARS-CoV-2 virus -- even the reference to SARS has been challenged here at UD -- on the prowl with 2-3 or possibly up to 49 strains already, we have to act under pressure where days count in the face of exponential growth. KFkairosfocus_{April 2, 2020
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If I had the virus and my life was in danger, I would ask for chloroquine (or whatever drug combination appeared most effective at the time). Do these drugs actually provide a net benefit? That's a separate question.daveS_{April 2, 2020
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Zinc is the killer, hydroxychloroquine is the facilitator. Here is a video from 3 weeks ago that is relevant to the cure for the virus and apparently what the South Koreans have done. It is from a medical site that prepares medical students for exams called MedCram. It shows that hydroxychloroquine is an ionophore (essentially a transporter to get into a cell) for zinc to enter the cell where zinc prevents the virus from replicating. So zinc is the essential ingredient. https://www.youtube.com/watch?v=U7F1cnWup9M&list=PLQ_IRFkDInv-NvRRUN0aqe51sMs188k8z&index=18 This video is from 3 weeks ago so why have so many people died unnecessarily in that time when a known solution was out there? I would blame the blinders of those who are traditional thinkers on this. As far as following traditional approval patterns for medicine approval, the current situation is different. As someone said in a website yesterday there are no double blind studies for parachutes. The site MedCram has dozens of interesting videos on medicine and so far 47 on the virus. Here is the home Youtube site for it https://www.youtube.com/channel/UCG-iSMVtWbbwDDXgXXypARQ Here is how it kills. ARDS or Accute Respiratory Distress Syndrome. This is what Dr. Zelenko was describing in his video with Giuliani. https://www.youtube.com/watch?v=okg7uq_HrhQjerry_{April 2, 2020
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@DaveS Derek Lowe is a scientist, and properly skeptical. For lay people: proper scientific skepticism is not disbelieving something, it’s reserving judgement until there’s adequate evidence. We’re still waiting for this drug, hopefully we’ll know in a few weeks.Jim Thibodeau_{April 2, 2020
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He's a man of many talents.daveS_{April 2, 2020
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Derek Lowe was a good pitcher and won a world series with the Red Sox, but I am not sure what he can offer in the way of science and medicine. ;) :cool:ET_{April 2, 2020
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The fact that "Ed George" was erecting strawmen is evidence he was not being properly skeptical about the new treatments.ET_{April 2, 2020
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Lowe does offer some detailed critiques of the methods used in Raoult's work, which is worth keeping in mind. The section entitled "This Latest Study" of this blog post contains some.daveS_{April 2, 2020
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DS, I have been tracking Raoult and other actual studies and set up protocols with a side helping of the FDA's approvals to date. On searching, I see his https://blogs.sciencemag.org/pipeline/archives/2020/03/20/chloroquine-past-and-present which on glancing is an article I saw and glanced through. Indeed, his feel free to read someone else's work in respect of overconfident mechanism suggestions is echoed in my earlier comments. Yes, it is always possible that what we imagine are causal effects are accidents that make mincemeat of our suggested efficacy and mechanisms. That possibility falls exponentially as evidence and cases accumulate. For France, tipping point has been reached and the US has taken a second step up the approvals ladder this weekend. As US testing started already, we will see further in coming days. KFkairosfocus_{April 2, 2020
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KF, Have you read Derek Lowe's take on chloroquine? If so, what do you make of it? (Apologies if you've already discussed this in previous threads).daveS_{April 2, 2020
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Ed George has been properly skeptical of this new scientific claim, which is the appropriate position. I’ve seen some other people be way too credulous, because they want to believe something is true. I hope it’s a miracle drug, But we are awaiting confirmation on its efficacy.Jim Thibodeau_{April 2, 2020
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F/N2: observe, my comment at 34:
I note, that by end of February to early March, there was already a considerable body of evidence of effectiveness on the table, as I have partly documented from a series of OPs here. Note, this specifically includes tests documented in the professional literature from 15 Years ago, post SARS, that Chloroquine was effective chemically against a broad range of RNA and DNA viruses. As it is a well studied and widely used drug, the translation between chemical and in vivo effectiveness should have been recognised. The REAL scandal and debate we should have been having — given the longstanding, pressing need for effective antivirals — is why there was not a concerted effort to test and approve it over a decade ago. I suggest, that it is a longstanding generic and that approvals processes are now extremely cumbersome and costly just might have something to do with that.
Set that against the backdrop of my earlier note in 31 how Bahrain, by Feb 26 began routine use based on existing evidence, with the result:
Total Cases: 499 of which 1 in severe condition Deaths: 4 Deaths/ Total Cases: (1%) Recovered: 272 Recovered/ Total Cases: (55%)
As noted there, Bahrain is relevant as the curve of cumulative cases there is clearly flattening, joining S Korea and possibly China in the group of countries that have beaten the epidemic.kairosfocus_{April 2, 2020
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F/N: Notice, Seversky at 27:
If chloroquine and azithromycin are effective against COVID-19 then great, let’s get them into full production as soon as possible. But it will take more than the word of a reality-show President who thinks the USAF has Romulan cloaking-devices to convince me. That will need to be confirmed by results from the large-scale trials that are being prepared now.
His highlighted if speaks volumes against the backdrop of what the OP reported from France, which corroborated what had been coming from China etc. So do his onward remarks on a tangential matter, his scorn for the current US President.kairosfocus_{April 2, 2020
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EG, do you really want to go down the long list of times that you and others have cast severe doubts on the utility of HCQ? Or, how often you have withheld substantial, operational agreement on when I have pointed out the FDA approval of March 19, including in OP? Which, would have shifted the balance of discussion. In short, the TONE of the exchanges up until this past weekend speaks far more than your weasel words do, and frankly weasel words they are as otherwise there should have been mutual agreement not sharpish exchanges. So, forgive me if in that context I overlooked points where you asserted what was actually highlighted by us, on the way to scanting the quality of evidence providing warrant for the promise and now credible effectiveness of the drug. Do you notice the tenor of your following words, "until a comprehensive clinical trial has demonstrated its efficacy [--> cf the trials in China etc] and, more importantly, its contraindications [--> cf. the long since known toxicity effects of the drug], it would be irresponsible to prescribe it to people with mild symptoms, even if they test positive"? Why are such words there when at the start point by March 19th FDA had approved compassionate and emergency use? Also, there were on the table studies in France, Australia and China, the latter with actual set protocols for use [--> see, for Canton aka Guangdong] so that studies in the US etc, strictly, were by way of corroborating replication, not pioneering studies? (Or, are we dealing with unwarranted dismissiveness to the pioneering Chinese work all the efforts since then build on?) And BTW, it is not helpful to be needlessly casting seriously loaded accusations such as "lie" in our teeth. Where, an operative word is, ADVOCATED. KF PS: Note this, from my response at 11 in the relevant HCQ wars, 4 thread:
[KF] who has been advocating broadcast use? (Apart from somebody deciding to swallow aquarium cleaner not for human consumption.) Nearest I see is that prophylaxis would go to critical health workers and maybe to those with danger-sign preconditions.
PPS: You, at 20 in thread, summarising with apparent approval:
Ontario has prohibited doctors prescribing chloroquine for COVID-19.
Where, HCQ Wars, 4 was about the second, 80-patient Raoult test and his linked in vitro studies that we learned later tipped the balance in France and led to US FDA second stage approval.kairosfocus_{April 2, 2020
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But until a comprehensive clinical trial has demonstrated its efficacy and, more importantly, its contraindications, it would be irresponsible to prescribe it to people with mild symptoms, even if they test positive.
No one here, nor from the White House, has ever said to prescribe it for mild symptoms. That was something YOU invented. Well, perhaps other tards invented it, too.ET_{April 1, 2020
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And we told you that it was only being used in hospitals where the patients were closely monitored. That is what we have been telling you and you went off on some tardic tangent. And then you said what we have been telling and now you are acting as if you said it first. KF's entire string of posts on the subject was about that- the treatments were to be used in hospitals under supervision. You are clearly just an ass and apparently proud of itET_{April 1, 2020
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KF
EG, no, you and others have not advocated for emergency use,...
KF, if you are going to lie, what is the point of trying to have a discussion. This is what I said:
Nobody is suggesting that this combination shouldn’t be used. If a patient in hospital tests positive I have no problem with having it administered on a routine basis. But until a comprehensive clinical trial has demonstrated its efficacy and, more importantly, its contraindications, it would be irresponsible to prescribe it to people with mild symptoms, even if they test positive.
Ed George_{April 1, 2020
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EG, no, you and others have not advocated for emergency use, but have dismissed evidence of efficacy as at best anecdotal and further claimed that until there was extensive testing to your satisfaction, it would be improper or even dangerous to suggest that it is promising. Now, you are re-writing. The problem in so interpreting the FDA approvals is that there is an earlier stage of approval dating to March 19 -- on the strength of which it seems the despised Mr Trump spoke of HCQ as a promising treatment -- for compassionate and emergency use. Further to all of this, the next step of expansion of approval is coming just after the second Didier Raoult study [of 80]. What I have explicitly argued is that there is mounting evidence of efficacy, as can be seen, with the implication that on known chemical effectiveness against viri and known ability to translate that into drug dose with a well known toxicity management framework, it becomes reasonable in the first instance to provide off label prescription and further reasonable -- not "touting" -- to point to this as a point of hope. KFkairosfocus_{April 1, 2020
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Y-you mean the virus was created deliberately? Edit: I misunderstood; I don't think that's what you're suggesting.daveS_{April 1, 2020
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CP, useful result, adding to the pattern. Of course, the test is not for the cocktail, but it helps us further see the clear antiviral impact again demonstrated. The pattern of repeatable, cumulative evidence is growing. As it does so, the chances of all of this being by chance drop exponentially. KFkairosfocus_{April 1, 2020
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Acartia Eddie:
So, it can only be prescribed in a hospital, and only if they aren’t eligible for a clinical trial. The very same restrictions that some of us have been raked over the coals for advocating.
Moar lies. This is the very thing we have been telling YOU.ET_{April 1, 2020
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FYI- Zinc kills bacteria by starving them of manganese, an essential element for them. Yes, I know that bacteria ain't viruses.ET_{April 1, 2020
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EG Third request, when did Trump use the word “promise” Vividvividbleau_{April 1, 2020
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KF@29, my understanding is that colchicine (often used for gout) causes the body to absorb more zinc, and is effective in reducing inflammation. That is why it is being researched as a possible treatment for COVID-19. I doubt there will be a magic cure unless a vaccine can be developed. Any effective treatment will probably involve a combination of drugs.Ed George_{April 1, 2020
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