More evidence hydroxychloroquine works

Yes a poll of doctors treating Covid patients. Your problem is?

 

Link is in the OP.

 

I am not a doctor and don't really understand much of the science behind the studies experts have done with respect to H. I do, though, understand that all the experts agree that it neither prevents nor cures, and it is not a legitimate treatment for covid-19.

https://www.sciencenews.org/article/covid-19-coronavirus-hydroxychloroquine-no-evidence-treatment

 

Trump has exploited the Swamp's snakes:

 

A very nice ad hom.

Helps dodge the substance, eh?

 

You want to get medical advice from a nutjob?

 

We've all been getting medical advice from a nutjob every since this started, a small man with a large ego, ruling the country from his office in Washington, never elected.

 

Sorry, i don't do requests.

 

What you don't do is provide proof of your claims

Ever

 

But Trump was elected.

 

I was talking about Fauci, not Trump.

Fauci, Wakefield, Tedros and others are not elected, yet their "recommendations" carry the force of law in many jurisdictions.

 

You prefer to have "elected officials" making political and not medical based decisions regarding public health?

Ohhhh

 

No, your study is not "enough to shut up anyone mocking HCQ." Do you really think that mentioning that HCQ has in-vitro viral inhibition properties is something new? It was known from the start and it was the very reason why Dr. Didier Raoult started experimenting with it. The problem is, from in-vivo to in-vitro there is a VAST difference. Did you miss this part of your paper?

"Indeed, the lack of selectivity of chloroquine and hydroxychloroquine for hERG (Fig. 6h) and other off-targets (Extended Data Fig. 12) may be related to the adverse cardiac drug reactions that have limited their use."

There is no doubt that HCQ has some in-vitro viral inhibition properties against the SARS-CoV-2. That was never in doubt and was known from the beginning. The problem is, the risks that it causes in-vivo FOR THIS POPULATION of people who suffer from Covid-19 (regardless of how safe it is for lupus, malaria, and RA) outweigh its benefits FOR THIS POPULATION (safety is always disease-specific). Given that the SARS-CoV-2 has a strong predilection for the heart fibers, trying to treat it with a cardiotoxic medication is not viable. That's exactly what the FDA said when they cancelled the emergency authorization: that the risks outweigh the benefits.

This is the case for many medications that have in-vitro activities against infectious agents. When you try to replicate the effect in-vivo, you find that the medication doesn't achieve sufficient concentration in the cells of the living organism to exercise its beneficial effects, without first reaching toxic levels for that organ or other organs. Directly adding something to a viral-infected cell culture in a lab to measure replication, is very different from taking a tablet by the mouth and getting SAFELY the same result in the living patient (among the reasons, because in the live patient the drug goes everywhere, to all organs).

Pharmacological research is full to the brink with hundreds of thousands of proposed compounds that had in-vitro efficacy but failed to prove clinical usefulness. That's actually the rule rather than exception: only a minority of drugs with in-vitro efficacy end up demonstrating safe in-vivo efficacy, enough to earn regulatory approval.

HCQ takes ten days to reach level in pulmonary tissues, and its main activity against viruses is linked to it being a ionophore for zinc. However there are better zinc ionophores out there (e.g. quercetin) that reach level much faster, and are therefore more useful than HCQ for Covid-19, and are without the cardiotoxicity.

At this point there is no more reason for a well-informed doctor to prescribe HCQ to a Covid-19 patient, and the ones still doing it are incompetent outdated fools who are unable to keep up with the latest developments.

And I'm not talking about this from the standpoint of "the left" - but rather, from the standpoint of medical science.

Let the doctors decide this, you say? It's been decided, dear.

And yes, if a doctor is stubborn enough to continue to prescribe some sort of quack "miracle" treatment AFTER science has debunked it as unlikely to work and detrimental, and AFTER the main agencies, specialty societies, and the medical boards have already issued warnings that the treatment is not only not efficacious but is also detrimental, absolutely the Board needs to sanction the doctor for practicing outside of the accepted standards of care. That's precisely what Medical Boards do. That's precisely their role.

For your information, a license to practice medicine doesn't come with a "carte blanche." This is a regulated profession and doctors are supposed to practice evidence-based medicine within the standards of care. Those who deviate, get disciplined, and with good reason.

Off-label practice is acceptable in controversial situations where benefits might be possible and risks might be small, but it is not acceptable once these benefits and risks get quantified and a consensus is built around the issue, which is the case of HCQ for Covid-19. FYI, there is no more HCQ controversy. It's been already established that it doesn't work and is harmful, for Covid-19 patients.

So, can a doctor still issue a prescription of HCQ for a Covid-19 patient? Sure. If the doctor has a valid DEA number and a valid NPI number, a pharmacy will honor the prescription. Prescription scripts, by the way, don't mention the indication. They just mention the strength, how many tablets, and how often to take them. There is no prohibition in place. But in case something goes wrong and a family files a complaint with the Board, yes, the Board will launch an investigation, and may conclude that the doctor practiced outside of the standard of care.

This issue is not coming from "the left." The regulatory and disciplinary roles of the State Medical Boards have been exercised like this for several decades and they have nothing to do with the left, the center, or the right. These roles apply to HCQ just like they apply to every other treatment known to Medicine.

 

What do you have to lose? Your life. HCQ has been shown to accelerate the death of otherwise recoverable Covid-19 patients. It is definitely NOT indicated especially for the situation you are mentioning, of a "dying" patient. For these, the viral replication phase is long gone. That patient is dying of the cytokine storm, and of the organ damage that the virus has already imposed (such as the acute inflammatory myocarditis, or the disseminated intravascular coagulation). Add HCQ, and you kill that patient faster. Some of the patients who have died of acute cardiac toxicity from HCQ could have been saved if given dexamethadone, instead. The advanced protocols for critical Covid-19 patients, nowadays, no longer include HCQ, and actually advise AGAINST using it.

I couldn't care less if the name of the drug came from Trump's mouth (and I shouldn't, given that he is not qualified to issue this kind of opinion). I care for the studies showing worse mortality in severe COVID-19 patients when treated with HCQ as compared to those who were lucky enough to be spared this detrimental treatment.

And that's also the opinion of the FDA, the American College of Cardiology. the American Heart Association, and my State Medical Board. I believe that these people know a bit more about this, than Thedimon.

 

Nope. The few studies that hinted at some efficacy are retrospective observational studies, and they were misinterpreted by journalists and pundits who have no clue about how to read a study and how to understand a study's limitations. Retrospective observational studies are not equipped to answer the question. They can merely introduce a hypothesis. That hypothesis then needs to be put to test with prospective, randomized, double-blind, controlled trials. This was done, and showed not only no efficacy for HCQ (not for severe cases, not for moderate cases, not for mild cases, and not as prophylaxis), but showed detrimental effects. End of the story.

Well, thankfully, because it shouldn't.

Agreed. It doesn't have any place in determining that, and it wasn't what determined it for the scientific community, which gave HCQ a very fair shake with hundreds of studies being done. And it did that not because of Trump (the vast majority of that community doesn't even live in the United States and couldn't care less about Trump) but rather because researchers were trying to find a treatment. Given that HCQ has in-vitro viral inhibition properties, it was fair to try it. It's been tried, and it failed.

No. It was attacked because it doesn't work and it causes cardiac toxicity for Covid-19 patients.

Possibly. But then, Trump should have kept his big mouth shut, because he is not qualified to comment on the efficacy or lack thereof, or the safety or lack thereof, of a proposed pharmacological treatment for a novel disease.

 

Clinical trials? Or observational studies with methodology flaws and a tone of intervening factors? Because the real randomized controlled clinical trials did NOT show what you are saying, much the opposite. Do you care to post your 57 "clinical trials"? Two real RCTs, one using it as prophylactic, and another one using it for mild cases, showed no efficacy. I've posted the links to them, in other parts of my posting history. Ever since, there's been more. Here, this journal watch post summarizes it:

https://www.jwatch.org/na52078/2020/07/30/hydroxychloroquine-ineffective-patients-with-mild-covid-19

Do you want more? Here:

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

What about this one?

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1009/5872589

Oh, and by the way, contrary to what you're saying, this one shows that HCQ slows recovery:

https://www.news-medical.net/news/2...n-to-slow-recovery-for-COVID-19-patients.aspx

About the in-vivo vs. in-vitro stuff I was mentioning earlier, look at what this link above says:

 

What makes you think that medical boards don't have a say? LOL
You're clearly unfamiliar with how this regulated profession called Medicine operates.

 

If HCQ is so darn poor as they would have us believe today, I wonder why it's been in use for so many decades, and why even the CDC approved of its efficacy, way back in 2005?

Why has the outbreak of Covid in Africa been so low key compared to other parts of the world? Could the common usage of HCQ have something to do with it?

 

I pretty much have read your last 4-5 posts and it's been incredibly enlightening from a place of clear medical experience and guidance. So I wanted to say thank you for these posts. Clearly Trump was trying to bolster what his team was telling him, without the necessary context to understand. Should he have done so? No, but could we have expected anyless from someone who likes to paint things over. If we've learned anything about these four years and the coronavirus it's that transparency and honesty are the key.

 

You're welcome. The sense of my posting is to try and bring down the huge amount of misinformation linked to this.

A poster like Thedimon seems to imply that the international medico-scientific community is involved in a vast conspiracy to discredit Trump. First of all, this is absurd. We'd have been delighted if HCQ had worked. We gave a HUGE fair shake to it, with HUNDREDS of studies. Second, we couldn't care less if Trump is a fan or not. Many of the studies started being designed and proposed even before Trump said anything about it. Third, the argument is that we debunked its (falsely) alleged efficacy just because Trump supported it. No, we did, because there is no efficacy. It doesn't work. Not in doses compatible with treating a live human being.

And if the motivation was to just destroy a medication touted by Trump, why in the hell we never said anything against remdesivir? Trump also touted remdesivir, and even engaged in decisive action to secure the world's entire stock of remdesivir then available, for the use of American hospitals (for which I thanked him). Why don't we disparage remdesivir? Because this one, does work! By now, two well-designed, full RCTs have shown that remdesivir works, both for severe cases, and for moderate cases, unlike HCQ.

So, what guides the medico-scientific community is not if Trump touts a medication or not. He touted both. One works. The other one doesn't. So, we supported the one that does work (remdesivir) and put down the one that doesn't (HCQ) and that was because of the result of the RCTs in both cases, not because of what some politician with no scientific or medical training thinks.

 

I was simply providing you with information you apparently didn't have. Since you reject it, I'll just consider it a waste of time and move on.

 

Information I didn't have? LOL, you haven't seen my posting history... I have a lot of information on this topic. The problem is rather that most people don't know how to interpret the evidence they are told about. There are 7 categories of strength of evidence in Evidence-Based Medicine. Retrospective, non-randomized observational studies are strength category 6, the one before last. Randomized controlled trials are category 1, the highest. You can show me Category 6 evidence as much as you want, it won't beat Category 1 evidence. It's as simple as that.

 

Glad that it is simple.

 

It was false

 

Then listen and follow it

Centrefield knows what he/she is talking about on this as it is o virus from his/her posts that they have a deepUnderstanding of research And in particular what we call Evidence Based Practice