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COVID-19 and the need for skeptics in science

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Now more than ever:

Since World War II, America has suffered two respiratory pandemics comparable to COVID-19: the 1958 “Asian flu,” then the 1969 “Hong Kong flu.” In neither case did we shut down the economy—people were simply more careful. Not all that careful, of course—Jimi Hendrix was playing at Woodstock in the middle of the 1969 pandemic, and social distancing wasn’t really a thing in the “Summer of Love.”

And yet COVID-19 was very different thanks to a single “buggy mess” of a computer prediction from one Neil Ferguson, a British epidemiologist given to hysterical overestimates of deaths, from mad cow to bird flu to H1N1.

For COVID-19, Ferguson predicted 3 million deaths in America unless we basically shut down the economy. Panicked policymakers took his prediction as gospel, dressed as it was in the cloak of science.

Now, long after governments plunged half the world into a Great Depression, those panicked revisions are being quietly revised down by an order of magnitude, now suggesting a final tally comparable to 1958 and 1969.

COVID-19 would have been a deadly pandemic with or without Ferguson’s fantasies, but had we known the true scale and parameters of the threat we might have chosen better tailored means to both safeguard the elderly and at-risk, while sustaining the wider economy. After all, economists have long known that mass unemployment and widespread bankruptcies carry enormous health consequences that are very real to the victims suffering drained life savings, ruined businesses, broken families, widespread mental and physical health deterioration, even suicide. Decisions involve tradeoffs.

COVID-19 has illustrated the importance of free and robust inquiry…

Indeed, every major scientific advance challenged the “settled science” of its day, and was often denounced as pernicious and false, even dangerous. The modern blood transfusion, for example, was developed in the late 1600s, then banned for nearly a century by a hostile medical establishment, “canceling” tens of millions of lives at the altar of groupthink and hostility to skeptics.

Peter St. Onge, “The COVID-19 Panic Shows Us Why Science Needs Skeptics” at Mises Wire

The thing is, it used to just be sympathizers of some unpopular viewpoint like ID getting deplatformed. Now, COVID-19 has raised the stakes, with so many official sources demanding obedience to conflicting and wrong ideas. And our neighbors can’t afford to ignore just how destructive the establishment line, unfettered and unhinged, can be.

It’s a good time to talk to them about the problems with Establishment Science today. Too much arrogance and politicking; not enough humility or integrity.

Comments
Jerry @ 323 - Is this true? I’m not aware of anything that shows this. Why don’t you present it? I and others have done. Repeatedly. But you keep on dismissing the evidence as irrelevant. ET @ 324 -
Earth to Bob- That is why we need the data I was asking for. The data that would show us how much zinc is in the patients’ cells.
But who cares if the same trials show no clinical benefit? Why send a lot of effort to get a secondary endpoint when the primary endpoint, the one that matters, is easier to obtain? And if the primary endpoint shows no benefit, who cares about the secondary endpoint? kf @ 326 - you can wave your arms all you want, but you're going to have to explain why there are several RCTs that show no effect of HCQ (e.g. see the second paragraph here for a list). What RCTs are there that show a positive effect?Bob O'H
August 6, 2020
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Jerry: Just found out the source for the opposition to HCQ in the United States. It is both financial and legal. If HCQ is designated an appropriate drug for the Virus, then by law no other drug can get emergency use authorization and is prevented from being pushed to the head of the line. Thus, there is big financial reasons for disparaging HCQ. I don’t know if this affects other drugs that also may be effective such as ivermectin. Which does nothing to explain all the clinical trials from other countries around the world saying that HCQ is ineffective against COVID-19. It would prevent Remdesivir and vaccines from quick approval and require more testing for each. It sounds like the law should be modified at least for this instance and it would stop the disparagement of HCQ and allow other drugs to proceed. You do realise that the US bought three months of the world supply of Remdesivir?JVL
August 6, 2020
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BobRyan: Sweden did not lock and their daily death rate continues to be close to nothing. The projections were for millions to be dead by June and the projections were wrong. Look at Denmark, Norway and Finland: similar countries culturally, geographically, politically and economically. They did lock down, they hit almost zero deaths far earlier than Sweden and their deaths rates are far, far below Swedens. Their economies are doing just fine because they were able to open things back up again fairly quickly.JVL
August 6, 2020
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BO'H: How in denial you are. You have swept away the evidence of successful treatment, have elevated critiques and misdirected or outright fraudulent studies --think how so many responded to Lancet! -- to a pedestal and now wish to dismiss the evidence of not just correlation but causal mechanisms. Then, you project a mirror image to me. Sad. KF PS: Start from the point that Zn is a recognised antiviral and that what promotes it in the cell will thus have associated antiviral properties. Then think about what happens if you do not understand a system with synergistic effects and try to play around component by component. Then, go look at the papers by Raoult et al, and specifically the study that reports on antiviral effects at plausible in-body concentrations. Then, figure out that a drug with 65 year track record has manageable toxicity and that it is able to move into the body when taken orally. That already shows that it is plausible that the in lab result will be mirrored in tissue. Then, look again at the facts from thousands of cases that show rapid, effective action when taken by the right people at the right time. Sharp progressive decline in virus load is a key result. But then, what we are seeing is the crooked yardstick effect in action. Once a crooked yardstick is taken as standard of straight, accurate, upright, whatever disagrees with the particular crookedness will be rejected -- including, what is actually straight, accurate and plumb. Not even a plumb line will move some locked into a crooked standard.kairosfocus
August 6, 2020
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And was does zinc therapy work with colds and flus?ET
August 6, 2020
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Earth to Bob- That is why we need the data I was asking for. The data that would show us how much zinc is in the patients' cells. What science do you do, Bob? You didn't know squat about the chimpanzee anatomy. You think blind watchmaker evolution is science and yet it is untestable trope.ET
August 6, 2020
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Because simply focusing on the results of the clinical trials, i.e. direct tests of whether HCQ works, undermines your argument?
Is this true? I’m not aware of anything that shows this. Why don’t you present it? Another doctor with almost 100% success against C19. There are several others. https://www.bitchute.com/video/Nuw30f6a4A2A/ This was made a month ago. His current stats are 325 treated. Two hospitalized and one death. So if caution is advised, what do you do if you get it? Answer, there is an effective treatment that works a lot of the time.jerry
August 6, 2020
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Just found out the source for the opposition to HCQ in the United States. It is both financial and legal. If HCQ is designated an appropriate drug for the Virus, then by law no other drug can get emergency use authorization and is prevented from being pushed to the head of the line. Thus, there is big financial reasons for disparaging HCQ. I don’t know if this affects other drugs that also may be effective such as ivermectin. It would prevent Remdesivir and vaccines from quick approval and require more testing for each. It sounds like the law should be modified at least for this instance and it would stop the disparagement of HCQ and allow other drugs to proceed.jerry
August 6, 2020
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kf @ 316 -
Jerry, guess why I have focused on the cumulative evidence on plausible causal processes and linked context of actual clinical results across thousands of cases?
Because simply focusing on the results of the clinical trials, i.e. direct tests of whether HCQ works, undermines your argument?Bob O'H
August 6, 2020
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ET - what you're asking for won't tell us, for the reasons I've indicated. Yes, I do know how science works, because it's what I do. I've also read about drug development and discussed it with people in the business, and this is a common theme: even if a drug works in vitro that doesn't mean it'll work in practice.Bob O'H
August 6, 2020
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rhampton:
ET, you are? I thought you had made up your mind.
YOU are the one who has made up their mind- all without the scientific data.ET
August 6, 2020
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Bob O'H:
what we’re interested in is whether there is an effective treatment for patients, i.e. human beings.
The data I am asking for will tell us why there is or isn't. Or do you not understand how the science works?ET
August 6, 2020
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Here is a list of 67 studies done on HCQ. I am not pointing to any specific study at the moment but am willing to look at each individually for discussion purposes. https://c19study.com/ So anyone who wants to dispute the relevance or non-relevance of any particular study feel free to do so. It may prove educational. The main reason I am commenting here at this time is to learn about the virus, clarify my understanding and to improve this understanding by articulating It through comments So far I have learned a lot from the comments made by others both supporting and challenging this understanding and links provided. I assume others have too. Just found this report on a study in Italy on over 3000 C19 patients. https://translate.google.com/translate?depth=1&pto=aue&rurl=translate.google.com&sl=auto&sp=nmt4&tl=en&u=http://www.francesoir.fr/opinions-entretiens/interview-exclusive-une-etude-italienne-sur-3-451-patients-confirme-lefficacite It’s a translation. My guess is that this will not make RHampton’s top 40 list. But I am sure he will find someone who will criticize it.jerry
August 6, 2020
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Jerry, guess why I have focused on the cumulative evidence on plausible causal processes and linked context of actual clinical results across thousands of cases? Including, the surprisingly relevant point that use as fish tank cleaner points to significant cross-kingdom bio activity thus attacks on core cellular processes, and to -- for a reasonable dosage range -- significant differential effects on simple vs complex life forms. KFkairosfocus
August 6, 2020
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there’s a comprehensive takedown of Risch here. Feel free to ignore it or find it irrelevant.
Why don’t you take the two or most three most relevant things from this guys rant and present it. It would be interesting to see what is actually the best argument against HCQ used appropriately. So far I haven’t seen anything from you or anyone else. But maybe you could focus in on a few given this source.jerry
August 6, 2020
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PS: A reminder on the significance of the Tuskegee atrocity, once a fortiori logic is applied, by way of marking up what W/pedia was forced to acknowledge: ********
The U.S. Public Health Service Syphilis Study at Tuskegee was a clinical study conducted between 1932 and 1972 by the United States Public Health Service.[1][2] [–> 40 years of sustained wrong, which had to be enforced through a warped understanding of ethics and epistemology, with overtones of racism similar to medical experiments on concentration camp inmates] The purpose of this study was to observe the natural history of untreated syphilis [–> decades after effective treatments were routinised by the late 1940’s] ; the African-American men in the study were only told they were receiving free health care from the Federal government of the United States.[3]
[--> evil under false colour, robes and ceremonies of medicine and science; with calculated misleading as pivot, extracting manipulated consent that caused improper exposure to diseases treated ineffectively when ADEQUATE evidence . . . adequacy is not perfection . . . existed that better alternatives were available.]
The United States Public Health Service started the study in 1932 in collaboration with Tuskegee University (then the Tuskegee Institute), a historically black college in Alabama. [--> misuse of credibility] Investigators enrolled in the study a total of 600 impoverished, African-American sharecroppers from Macon County, Alabama.[3] Of these men, 399 had latent syphilis, with a control group of 201 men who were not infected.[2] [--> oh, yes, the gold standard was applied within the study and the study as a whole was itself a control on efficacy of other treatments: natural, untreated course] As an incentive for participation in the study, the men were promised free medical care, but were deceived by the PHS
[--> deception, a key to seeing the ethics failure and don't tell us oh deliberately mislabelled sugar pills etc are not deception under colour, robes and ceremonies of medicine and science]
, who disguised placebos, ineffective methods, and diagnostic procedures as treatment.[4]
[--> REPEAT: "who disguised placebos, ineffective methods, and diagnostic procedures as treatment"]
The men who had syphilis were never informed of their diagnosis, despite the risk of infecting others, and the fact that the disease could lead to blindness, deafness, mental illness, heart disease, bone deterioration, collapse of the central nervous system, and death.[5][6][7][8]
[--> are people being told that as you are high risk and CV19 is fast moving with damage already in lungs per Raoult's 2000+ CT scans on 500+ patients, when symptoms emerge? That death is a significant, rapid potential outcome on placebos? that HCQ+ cocktails have several lines of evidence pointing to likely rapidly acting efficacy?]
According to the Centers for Disease Control and Prevention, the men were told that they were being treated for "bad blood,” a colloquialism that described various conditions such as syphilis, anemia and fatigue. "Bad blood"—specifically the collection of illnesses the term included—was a leading cause of death within the southern African-American community.[2] The men were initially told that the study was only going to last six months, but it was extended to 40 years.[2] After funding for treatment was lost, the study was continued without informing the men that they would never be treated. None of the infected men were treated with penicillin despite the fact that by 1947, the antibiotic had become the standard treatment for syphilis.[9]
[--> so, what about the cumulative body of evidence since 2005 on likely efficacy of HCQ+ cocktails? Or, is that to be branded with a scarlet letter, dismissed as not meeting the gold standard that rests on deceptive practice . . . MISLABELLED, ineffective pseudo treatments in the face of life/death are deceptive . . . then marginalised and censored?]
Study clinicians could have chosen to treat all syphilitic subjects and close the study, or split off a control group for testing with penicillin. Instead, they continued the study without treating any participants; they withheld treatment and information about it from the subjects.
[--> So, how much more is it to be challenged when in the face of cumulative evidence of efficacy, treatments are sidelined and it is demanded that people subject themselves to life/death situations to "prove" what is already readily shown, save where studies are fail-by-design: too late in the U/L trajectory, wrong demographic, dubious statistics like Lancet, etc?]
In addition, scientists prevented participants from accessing syphilis treatment programs available to other residents in the area.[10] The study continued, under numerous Public Health Service supervisors, until 1972, when a leak to the press resulted in its termination on November 16 of that year.[11] The victims of the study, all African-American, included numerous men who died of syphilis, 40 wives who contracted the disease and 19 children born with congenital syphilis.[12] The 40-year Tuskegee Study of Untreated Syphilis in the African American Male study was a major violation of ethical standards. [--> ethical failure] Researchers knowingly failed to treat participants appropriately [--> oh, how familiar] after penicillin was proven [--> empirical investigations cannot prove but can warrant a prudent conclusion] to be an effective treatment for syphilis and became widely available.[9] [--> how widely accessible are elements of HCQ cocktails? I submit, quite widely] Moreover, participants remained ignorant of the study clinicians’ true purpose, which was to observe the natural course of untreated syphilis.[3] [--> deception, deception, deception is deception] The revelation in 1972 of study failures by a whistleblower, Peter Buxtun, [--> So, how are whistleblowers currently being treated? see how it pinches when the shoe is on the other foot?] led to major changes in U.S. law and regulation concerning the protection of participants in clinical studies. Now studies require informed consent [--> what, really, is properly informed consent given what we are seeing now?],[13] communication of diagnosis and accurate reporting of test results.[14] [--> what about the right to access the best evidence and accessible treatments in the face of emerging pandemic?] The U.S. Public Health Service Syphilis Study at Tuskegee, cited as "arguably the most infamous biomedical research study in U.S. history,"
kairosfocus
August 6, 2020
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India had one of the most stringent lock downs in the world. They had 2 single day spikes in June, but mostly shows an upward trend of daily deaths continuing today. https://www.worldometers.info/coronavirus/country/india/ Sweden did not lock and their daily death rate continues to be close to nothing. The projections were for millions to be dead by June and the projections were wrong. https://www.worldometers.info/coronavirus/country/sweden/ South Korea did not lock down and they had their spike in early March. They are another country projected to have millions dead, but have a daily death rate close to nothing. https://www.worldometers.info/coronavirus/country/south-korea/ There are 2 other countries who did not lock down, Turkmenistan and Tajikistan, both of which are about as reliable as China for information. A United States navel ship had an outbreak and 1 sailor died. Cruise ships with outbreaks were not floating morgues, even though the passengers were mostly older and overweight.BobRyan
August 6, 2020
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BO'H, it is obvious that you did not seriously note that say Dr Raoult's lab results targetted plausible in tissue concentrations when he demonstrated in lab effects. This was a key part of his results. Where, again, he is a major, distinguished researcher heading a relevant institute based in a 4-hospital cluster with what 3500 or so beds. I get the strong impression that he is being rhetorically belittled, marginalised, disregarded through deconstructionism. As I have noted, HCQ is known to be effective as a drug when taken orally and to have manageable side/toxic effects. Indeed the fish tank test is one of the key insights: the fish thrive, the crud dies, i.e. complex vertebrate life forms have manageable toxicity, the simpler crud life forms do not, for relevant zones of concentration. Other components of the cocktail are similarly dosed in reasonable ranges; you already know Zn is not in dispute as an antiviral and HCQ plausibly acts as a promoter by weakening mechanisms that normally suppress Zn conc in the cell. In the face of disease, some inhibition of cellular function is tolerable for a few days, to block a viral disease process. You also need to address the ethics-epistemology issues drawn out through the Tuskegee syphilis atrocity and highlighted above, the gold standard notion is fallacious ethically and epistemologically. Evidence is evidence and enough of it, esp. when convergent, is decisive. Placebos are sometimes unethical for cause as people are not lab rats, and are likely to take far too long in the face of exponentially growing epidemics. KFkairosfocus
August 6, 2020
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RH7 & BO'H: You are both off track. Perhaps, it has escaped you that in the above, I gave causal dynamics, starting with implicit antiviral action of Azithromycin and the functionality of Zn. In that context I pointed out the known role of HCQ as a drug and its demonstrated in vitro confirmation of effect on relevant viruses. I even pointed out that its biochemical activity is extremely broad spectrum to the point of use as fishtank cleaner (since the '70's IIRC), which means that among its attack modes are effects that target core cellular life processes common to several kingdoms of life. Obviously, some of these cross over into antiviral activity, indicating interference with D/RNA and/or protein replication mechanisms. Which points directly to the ionophore activity and promotion of higher Zn concentration in the cell, which as just that inhibitory power. It probably has other core process modes of attack. The logic, then, is that we are dealing with a cocktail pivoting on a drug known to be effectve when taken orally and to have manageable risks (Pharmacology, being the study of poisons in small doses, i.e. all drugs have toxicity. It is possible to have toxicity with water!) It has known core cellular life attack modes, from efficacy as fishtank cleaner, implying some attacks are on absolutely core cross-kingdom metabolism and/or key replication processes. Some of which intersect with viral pathways for replication, hitting from the literature both D and R type viruses. So, it can cross the gut into the body and in plausible conc will have biochemical effects. That is why it has significant observed effects during the actual viral stages of SARS2, CV19 infections. Though it is an anti-inflammatory, attacking therefore some elements of the cytokine storm, there is such a thing as too much damage, too little reserve capability to recover. System breakdown implies that once we are late in the U/L trajectory, flatlining -- death -- is a significantly likely outcome. That is why studies that are too late, in stages where damage is in place, secondary infections and out of control immune responses are liable to be in action, will produce marginal or negative results. Similarly, in population segments that are less vulnerable, effects will be marginal, there was no difference to be made. Misdirected studies will give misleading results. Which has clearly happened. The clinical results from research targetting early, viral stages before hospital admission and off label use targetting vulnerable populations early in the trajectory are thus likely to work. Which is precisely what we see, once guavas are not compared with coconuts or mushrooms. Here, we should also note asymptomatic damage so once symptoms manifest the 2500 CT scans on 500+ patients ordered by Dr Raoult make that clear. Which BTW underscores his position as a leading researcher. In that context, the responsible position is clear, it is plausible, on sufficient track record, that the Raoult-Zelenko-Swiss protocol will be effective if given early in the U/L trajectory of CV19, and likely other similar viral diseases. Side effects are manageable. No other treatment is comparably cost effective, especially the business as usual de facto standard flu like complaint response. Given ethics-epistemology issues and time lags to get through major studies, questions on effectiveness and timeliness of novel vaccines etc, It is therefore reasonable to use the protocol in the face of a fast spreading deadly pandemic. That is what several voices have argued only to be shunted aside, marginalised and even personally attacked, including with threat of loss of licence. History, for cause, is going to find us sorely wanting. KFkairosfocus
August 6, 2020
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ET @ 304 - what we're interested in is whether there is an effective treatment for patients, i.e. human beings. What you describe is in vitro activity. You may well be totally right, but it's only relevant if the same activity occurs in patients at doses that can be safely prescribed. That's why we need clinical trials.Bob O'H
August 6, 2020
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Jerry @ 302 - there's a comprehensive takedown of Risch here. Feel free to ignore it or find it irrelevant.Bob O'H
August 5, 2020
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ET, you are? I thought you had made up your mind.rhampton7
August 5, 2020
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And we are still waiting on the science and the dataET
August 5, 2020
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After two weeks battling COVID-19, State Rep. Randy Fine (R-Palm Bay) posted on Facebook that he needed his lungs X-rayed as his symptoms now included a recurring fever and a hacking chest cough. He remarked that the hydroxychloroquine therapy he had been on proved ineffective. (New Material) ... Despite this, believers in the treatment have persisted. “He didn’t use the HCQ correctly,” a comment said on Randy Fine’s page. “You must take zinc with the hydroxychloraquine. (sic) The zinc is the magic bullet and the hydroxychloraquine (sic) carries it so it can prevent viral replication. Just curious, did you take the zinc too?” “Yup. Sorry to burst the magic bubble,” Fine shot back. In fact Fine said he took the drugs on the recommendation and prescription of his doctor, and contrary to assertions that the public is being denied access to the drug, Fine said he had no problem filling his prescription at CVS. https://www.floridatoday.com/story/news/2020/08/04/not-magic-says-rep-fine-hydroxychloroquine-therapy-covid-19/5573368002/rhampton7
August 5, 2020
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At least five randomized controlled studies say hydroxychloroquine doesn’t help If you want to know if a drug works, ideally the only difference between a patient who gets it and one who doesn’t is — no surprise — the drug itself. That’s harder to do than meets the eye. People aren’t identical. You can weigh them, look at their medical histories, check their blood oxygen levels and temperature, and yet, you still might miss something. That’s where randomly assigning patients to treatment and non-treatment groups comes in. "You don’t know all the possible things going on in the background and all that noise is what randomizing helps filter out," said Boston University infectious disease modeler Brooke Nichols. "It’s the best way to be sure that the only effect is the effect of the drug." Letting a computer program assign patients also prevents any subconscious choices by doctors from distorting the results. The whole approach is designed to take human foibles out of the picture. To really minimize the human factor, not only do you randomly assign patients to groups, but the patients and the health care workers themselves don’t know what group they are in. So everyone gets a pill, but for half of them, the pill might be just sugar or something equally neutral. That neutral pill is a placebo. "That’s the gold-gold standard of research," said Nichols. "And just one one small notch below that is the randomized controlled trial without a placebo." 1. A Cluster-Randomized Trial of Hydroxychloroquine as Prevention of Covid-19 Transmission and Disease, MedRxIV, July 26, 2020. No placebo. 2. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19, New England Journal of Medicine, July 23, 2020. No placebo. 3. Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19, Annals of Internal Medicine, July 16, 2020. Placebo used. 4. No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19, Recovery Trial - University of Oxford, June 5, 2020. No placebo. 5. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19, New England Journal of Medicine, June 3, 2020. Placebo used. https://www.politifact.com/factchecks/2020/aug/05/brett-giroir/yes-least-five-randomized-controlled-studies-say-h/rhampton7
August 5, 2020
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Here's the confusing part with respect to science: 1- It has been demonstrated, scientifically, that HCQ is an ionophore 2- It has been so demonstrated that ionophores allow more zinc into cells than the regular zinc transportation system does 3- And it has been so demonstrated that the extra cellular zinc prevents viruses from replicating Which of those 3 has been demonstrated to be not true in any of the studies conducted?ET
August 5, 2020
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A comparison of 2,7 billion people in places with wide spread HCQ use vs limited or no use. https://hcqtrial.com/
Many countries either adopted or declined early treatment with HCQ, forming a large country-randomized controlled trial. 2.0 billion people were assigned to the treatment group, and 663 million to the control group. As of August 5, 2020, an average of 37.8/million in the treatment group have died, and 438.5/million in the control group, relative risk 0.086. After adjustments, treatment and control deaths become 78.2/million and 626.6/million, relative risk 0.12. Confounding factors affect this estimate, including varying degrees of spread between countries. Accounting for predicted changes in spread, we estimate a relative risk of 0.21. The treatment group has 79.1% lower chance of death. We examined diabetes, obesity, hypertension, life expectancy, population density, urbanization, testing level, and intervention level, which do not account for the effect observed.
Is this true? Very long analysis but how valid. I can see the nit pickers ready and willing.jerry
August 5, 2020
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the signitories of that response include several Yale epidemiologists.
If the Yale academics had a valid objection, don’t you think they would pointed to it. But they didn’t because no one on the planet has done so. Maybe a little too emphatic but I have yet to have seen anyone. And you and no one else here has done so.
does it bother you that most of the studies the Swiss use to justify their protocol are of the sort you’ve dismissed as irrelevant?
I am sure there may be some. There about a hundred studies. Why don’t you point out the ones that are irrelevant. We can then examine each.jerry
August 5, 2020
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The ???????? South African Department of Health says it does not recommend the use of the controversial anti-malarial drug hydroxychloroquine as a Covid-19 treatment. Popo Maja, a spokesperson for the Department of Health, said South Africa has never recommended hydroxychloroquine as a Covid-19 treatment, but it had been used as a clinical trial under conditions where patients were carefully monitored for any adverse effects. “The National Department of Health regularly reviews evidence from clinical trials and adjusts guidelines accordingly,” it said. The department, however, did advocate for the use of dexamethasone, which it said had reduced mortality rates among patients who were severely infected with Covid-19. “Dexamethasone has been shown to reduce mortality amongst patients with severe Covid-19 disease, and all patients requiring oxygen should receive a 10-day course of dexamethasone. https://www.iol.co.za/news/south-africa/sa-hospitals-stance-on-the-controversial-hydroxychloroquine-drug-as-covid-19-treatment-64ec87fc-6821-4b31-b631-d427b37919acrhampton7
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COntinued… But to illustrate, I’ll give one observational example, since I think 100 people have emailed it to me in the past week. This is one of Didier Raoult’s studies, appearing in Travel Medicine and Infectious Disease. They report on 3737 patients with COVID-19. These were mostly outpatients, and the study states that, barring contraindications, they were prescribed 200 mg of HCQ three times a day for 10 days, with 5 days of azithromycin. They then compared the 3119 people who took that regimen for at least 3 days with 618 who didn’t. In the observational setting like this, the key question is, why did they not take the medications? Looking at Table 1 in the paper, we can see that at baseline, these groups are quite different. Table 1 https://img.medscapestatic.com/article/935/058/935058-fig12.png?interpolation=lanczos-none&resize=306:* Those who took the standard therapy tended to be younger; 53% were under age 44 compared with 36.4% who got the other treatments. They had less cancer, less diabetes, less chronic heart disease, and lower NEWS scores, which is a measure of disease severity. In other words, this was a group poised to do well. The treatment wasn’t assigned randomly; it was given to the healthiest. That’s not unethical or anything, by the way. It’s totally reasonable to be careful about who you give drugs to. It just makes it harder to interpret the results. And the results were better in the group who got the HCQ regimen: 0.5% death rate compared with 3.1% death rate. Table 2 https://img.medscapestatic.com/article/935/058/935058-fig13.png?interpolation=lanczos-none&resize=306:* From Lagier JC, et al. Travel Med Infect Dis. 2020;36:101791. doi:10.1016/j.tmaid.2020.101791 Now, you can adjust for baseline differences. Here, they adjusted for that severity score and comorbidity score — not age or anything else — and still found significance. But let me highlight two issues with adjustment. First, adjustment isn’t magical. You have to adjust for all the factors that are different at baseline to get an unbiased estimate of treatment effect. Second, you don’t know all those factors. You can only adjust for what you measure. Unmeasured differences in the groups will always be present, with one exception. You guessed it. If you randomize, you will balance not only measured differences but even unmeasured differences between the groups. That’s why clinical epidemiologists like me get so psyched about randomization. https://www.medscape.com/viewarticle/935058rhampton7
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