Re: Covfefe-19 part 6: Waiting For Advice from Kid Rock and Tiger Woods now.
Copied from the D1 thread.
My post regarding an RCT that is currently being conducted under the leadership of a colleague, Dr. Dave Boulware, is "pimping" HCQ?
I don't have any axe to grind here, but apparently you do.
If you want to falsely accuse US healthcare professionals as well as those around the globe (India, Germany, France, etc.) who are currently administering HCQ/AZ to CoV-19 patients with measured success of "pimping" that's entirely up to you. Go ahead and embarrass yourself.
I think they're being irresponsible, yes. But only one of us is embarrassing himself. Are you going to point to controlled studies these doctors are conducting with results? Or just anecdotal reports from Hannity and Dr. Oz?
It's noteworthy that Kansas City area physicians. as well as others in several states are continuing to treat CoV-19 patients with HCQ/AZ and are showing marked improvement in the reduction of the viral load. Major medical centers including the University of Washington and Mass General have added HCQ to treatment options. Other state pharmacy boards including Texas, Louisiana, Ohio and North Carolina have approved its use under physician care by prescription only which prevents individuals from misusing the drug by self-medicating.
Really? They are? Where's the data? What are the study parameters? I'm sure you have those links handy, especially using words like "marked improvement". Because normally we leave words like "marked improvement" to the marketing departments.
State pharmacy boards approving a drug to be used only means nothing without data. It doesn't mean there's evidence of efficacy, only that we're in a pandemic emergency and we're desperate and making ill-informed decisions based on anecdotal data. We don't know if the drugs are effective, we don't know what the side-effects are, and I'm not sure we have anything close to informed consent.
Yesterday the FDA and The Department of Health and Human Services (HHS) approved HCQ products to be distributed and prescribed by doctors through the Strategic National Stockpile to hospitalized teen and adult patients with CoV-19 as appropriate.
HHS said Germany’s Sandoz has already given 30 million doses of HCQ to the Strategic National Stockpile, and Bayer has donated a million doses. Pfizer has announced positive data for the use HCQ/AZ in an RCT recently completed in Marseille, France (see below).
I wouldn't bother quoting the studies out of Marseille. They're wrought with bad science, they're limited in scope, and have dubious conclusions. Regarding donations, those are politically and likely financially motivated decisions. Not evidence of anything resembling science.
I'd like to see the evidence to confirm your accusation that Dr. Didier Raoult MD. PhD. is a "fraud". Arguably, his previous small study raised some concerns on the research design side. But Dr. Raoult was officially a member of the first scientific council set up by French President Macron to advise him on the CoV-19 pandemic. He's definitely NOT a fraud.
Wildcard already posted links showing Raoult photoshopped gels and other stains. Literally copied and pasted. It was obvious. He was even banned from publishing in the American Society of Microbiology for a year because of his fraud. There are six separate cases of questionable data in his papers that look like outright fraud.
In fact, Dr. Raoult and a collaborative team of 28 microbiologists, physicians, biostatisticians, and pharmacologists in Marseille just completed and published the largest RCT to date last week on March 27 involving 80 CoV-19 patients who were treated with HCQ/AZ. The study was conducted at the University Hospital Institute Méditerranée Infection in Marseille, France and financially supported by the French National Research Agency.
And it's already being skewered for many of the same reasons the original study was.
The median age was 52 years (range 20 to 86) with nearly 1:1 male/female. The primary therapeutic objective was to treat patients who have moderate or severe infections at an early enough stage to avoid progression to a serious and irreversible condition. The elimination of viral carriage in the human reservoir of the virus was recognized in the study as a priority.
57.5% of the patients had at least one chronic condition known to be a risk factor for the severe form of CoV-19 with hypertension, diabetes and chronic respiratory disease being the most frequent. The mean Polymerase chain reaction (PCR) (a method used to copy and amplify specific DNA samples for detailed analysis) CT value was 23.4. A PCR CT value < 34 means the patient has tested positive for CoV-19.
No, it means that test did not detect enough of the markers to be considered positive. It doesn't mean the patient is negative or positive or that they weren't going to be shedding the virus through other means. More on this in a second.
Also, if the study was to look at preventing the progression of the disease to severe, it seems fairly odd to remove people who died or progressed to the ICU from the study's results.
A rapid fall of nasopharyngeal viral load tested by PCR was noted, with 83% negative at Day 7, and 93% at Day 8. The number of patients presumably contagious (with a PCR CT value <34) steadily decreased overtime and reached zero on Day 12.
Hey, that's great! I'm hoping you can explain this then:
<img src=https://els-jbs-prod-cdn.jbs.elsevierhealth.com/cms/attachment/78a4c1b5-3623-425a-81ad-d857a45a5829/gr1.jpg>
From the Lancet, a journal with some actual credibility.
You'll note that throat swab PCR tests come back negative after a mean of 16.7 days after first symptom onset. Also worth noting the French study doesn't discuss time from first onset of symptoms (they even included four people who were asymptomatic!) to negative tests. In the Lancet study, the fecal tests come back positive an average of 10+ days after the throat swabs are negative. Just because the PCR tests from one sampling method came back negative doesn't mean the patients had an outcome different than the natural progression of the disease.
It would have also been more helpful if the French study had discussed the sensitivity of the testing methods and whether false positives and negatives could influence the results. But, alas, they didn't.
Another great article I read by Derek Lowe asked why a simple cutoff of Ct <34 was used instead of tracking actual patient tracking in the larger study. Of those that were still positive on subsequent days, did they get worse? Slightly better? Much better? We just don't know because they don't include the full data for each patient, just aggregated.
The article also questions the methodology. Of the 80 that we’re <34 Ct on Day 0, on Day 1 only 70 tested positive? That would mean the treatment worked overnight on ten? Presumably the professor would claim they were from the 49, but we don’t know because he didn’t think it important to include that data. I’m skeptical at best. The article goes on to question why we aren’t seeing individual patient data for PCR counts instead of aggregated data which really doesn’t tell us anything. Why not look at whether viral loads were actually decreased at a quicker rate than the control group?
There was also some interesting discussion of their testing methods on PubPeer (
link)
1/2 - Cont'd
So, in the hydroxychloroquine study that showed "100% cure," 4 patients who went to ICU or who died were excluded from the reported results because the fact that their condition worsened made them fall outside the study's criteria of what to report. <a href="https://t.co/l8Qa9HJ64K">https://t.co/l8Qa9HJ64K</a> <a href="https://t.co/ABqRiWrsJF">pic.twitter.com/ABqRiWrsJF</a></p>— Taniel (@Taniel) <a href="https://twitter.com/Taniel/status/1247590404226252802?ref_src=twsrc%5Etfw">April 7, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
