2020-04-08 15:11 from wizard of aahz
Vioxx. That's about all you need to think about. Pain medication.
Worked great. Caused strokes and heart attacks.

Every doctor I talked to said that pulling Vioxx from the market was stupid.
It was a media driven sensation. Many took it themselves for their aches and pains.

I took it for a brief period. It was a wonder drug.

Annals of Internal Medicine has some choice words:

"In the desperate search to find effective treatments for coronavirus disease 2019 (COVID-19), 2 generic drugs, used largely by rheumatologists and dermatologists to treat immune-mediated diseases, have entered the spotlight. The antimalarials hydroxychloroquine (HCQ) and chloroquine (CQ) have demonstrated antiviral activity against severe acute respiratory syndromebcoronavirus 2 (SARSbCoV-2) in vitro and in small, poorly controlled or uncontrolled clinical studies (1b3). Normally, such research would be deemed hypothesis-generating at best. A tweet by President Trump on 21 March 2020 claiming that the combination of HCQ and azithromycin bha[s] a real chance to be one of the biggest game changers in the history of medicineb accelerated a worldwide run on the drugs, with pharmacies reporting shortages within 24 hours."

https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic what-every-clinician

New research/preprint.

Title: No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection

https://www.sciencedirect.com/science/article/pii/S0399077X20300858

And there you go. There is now no conclusive evidence either way, because the loudest voices are now pro or anti HCQ based on whether they are pro or anti Trump.

<---- likes to look at the actual science.

It's idealistic to be able to say "science is objective" but we all know that much of what passes for science these days is just someone's computer model that spits out the same answers regardless of what data you put in. And then when people disagree about it someone inevitably says "obviously you hate/deny science".

Undoubtedly there are already clinical trials underway, evaluating the efficacy of HCQ for treating the chinavirus. It is also true however, that we probably do not have time to wait for them to complete in the typical time frame, and we're going to need to rely on initial indications more than usual. This is why it will be good if a mountain of anecdotal evidence emerges quickly.

As for me, I'm siding with the pro-HCQ crowd because Bill Gates is on the other side.

Here's some anecdotal evidence for you:
A study of 81 patients in Brazil was halted early for safety reasons after Covid-19 patients taking a higher dose of chloroquine developed irregular heart rates that raised the risk of a potentially fatal heart arrhythmia.

France reported 43 cases of heart incidents linked to treating coronavirus patients with hydroxychloroquine.


Personally, I believe the HCQ probably provides lots of benefits for Covid-19. But it also provides lots of risks. A true case of informed buyer beware.


Give it to try to save someone - sure. But it's not a miracle drug.

what I'm reading is that many NYC hospitals are giving HCQ experimentally to large numbers of patients. some doctors believe it may help a little if given early. nobody believes it's a game-changer.

Science is far from settled. That's the point. Anecdotal evidence. Defined as such. Even Ragnar's Vioxx comment from above where he said it was a great drug for him. Yes. It was great for him. And for millions of other people. But if it's not a good drug for 1% of people do we still give it out? What about .1%? or 10%. Do we give it to whomever wants it with careful warnings? If it's 10%, what do we do for the 10% that take it and have issues? I'm not saying anyone's correct, I'm saying that there are ethics involved and it's not clear cut and those who think that it's clear cut may not be willing to look at all the sides of the issues.

That's the point: people who say "the science is settled" are generally trying to suppress any challenges to their own conclusions. This is of course the opposite of the practice of actual science, which welcomes new data even when it shakes the box and forces you to re-evaluate everything.

As for the Brazilian study, all references I can find to it seem to point back to a NYT article, which seems to have a political rather than medical agenda, and also doesn't indicate whether the 11 fatalities were caused by the medication or if they simply succumbed to the virus anyway.

So we still don't know, and that's kind of the point. I'm not concluding that this specific drug is definitely going to be effective, but I'm not giving up hope either.

...and by "conspiracy theories" I mean that the following is 100% Objectively True (tm) unless someone can change my mind.

Here's what I'm thinking at this point:
1. China manufactured the virus in the Wuhan biolab, using the nearby wet market as a convenient release vector.
2. China already has the vaccine, and has already administered it to ranking members of the CCP.
3. 2 million domestic fatalities is, to them, a small price to pay to knock down the rest of the world.

Can you imagine the kind of panic that would be going on if the pandemic had occurred in 2012, when many people "knew" that it was the end of the world because of the Mayan calendar?

there is at least one other antiviral agent that shows far more promise... statistically significant data showing an ability to reduce viral load in one study, although unfortunately there is not enough data to show that this actually translates to clinical outcomes

Remdesivir?

Still anecdotal. But it's starting to get some more results.

Real results would be nice -- for any treatment. One of my concerns here is that it's starting to look like a shootout between a $20 treatment that is available as a generic, vs. a $1,000 treatment that enriches Big Pharma.
I'd like to believe that clinical trials are 100% safe from being influenced by non-medical interests, but knowing how the world works colors me skeptical.

It's frustrating and scary and a bit annoying because the one thing we know for sure is that we don't have the full picture. I don't believe everything I hear, but when I hear something even remotely plausible I like to immerse myself in it, try it on for size and see how it feels. So far, the idea that China knows more than they're telling us still "feels" plausible.

I guess this was inevitable. The first federal criminal charges have been filed in connection with chloroquine hucksterism:

https://www.cnn.com/2020/04/17/us/doctor-charged-hydroxychloroquine-trump/index.html

Lots of things are possible, if not "plausible", but if we have absolutely no evidence for any of them, what do we have