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Old 03-25-2020, 07:12 AM
Jim Peebles is offline
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Legality of Nevada malaria treatment ban


From:
https://www.usnews.com/news/best-sta...virus-patients
"Sisolak [the Governor if Nevada] signed an emergency order earlier Tuesday barring the use of anti-malaria drugs for someone who has the coronavirus. The order restricting chloroquine and hydroxychloroquine came after President Donald Trump touted the medication as a treatment and falsely stated that the Food and Drug Administration had just approved the use of chloroquine to treat patients infected with coronavirus. Sisolak said in a statement that thereís no consensus among experts or Nevada doctors that the drugs can treat people with COVID-19."
Is this even legal? What about the "right to try" law? What about off label use of an FDA drug approved for something else? Is the Nevada Governor practicing medicine without a license? Can anyone harmed or whose family members are harmed from not being able to use the drugs to treat Covid-19 sue him? How can he be removed from office?
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Old 03-25-2020, 05:13 PM
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Here's the text of the NYC ban:

Quote:
No pharmacist shall dispense hydroxychloroquine or chloroquine except when written as prescribed for an FDA-approved indication; or as part of a state approved clinical trial related to COVID-19 for a patient who has tested positive for COVID-19, with such test result documented as part of the prescription. No other experimental or prophylactic use shall be permitted, and any permitted prescription is limited to one fourteen day prescription with no refills.
https://www.governor.ny.gov/news/no-...ster-emergency

Nevada is generally the same, I think Ohio is another, and I don't know how many other states.

I think the article you quote misrepresents what Trump literally said about FDA approval: they are welcome to their opinion, but it won't win any converts in the "Trump vs liberal media" war
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Old 03-25-2020, 05:29 PM
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No pharmacist shall dispense hydroxychloroquine or chloroquine except when written as prescribed for an FDA-approved indication; or as part of a state approved clinical trial related to COVID-19 for a patient who has tested positive for COVID-19, with such test result documented as part of the prescription. No other experimental or prophylactic use shall be permitted, and any permitted prescription is limited to one fourteen day prescription with no refills.
It seems to me that's a mostly reasonable limitation to be enacted in a time of emergency on a regulated/prescription-only substance which has great medical use but is currently being blatantly misused despite recommendations to the contrary, and is now dangerously scarce for legitimate use.

I worry about the "14 day no refills" language though, and hope that doesn't prevent folks with rheumatologic diseases from getting their prescriptions refilled. I just started a new lupus patient on it the other week and he'll need it daily, perhaps for life (and yes, it's often lupus and House is an idiot who deservedly got kicked out of my alma mater).

Last edited by Qadgop the Mercotan; 03-25-2020 at 05:30 PM.
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Old 03-25-2020, 06:34 PM
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Originally Posted by Qadgop the Mercotan View Post
It seems to me that's a mostly reasonable limitation to be enacted in a time of emergency on a regulated/prescription-only substance which has great medical use but is currently being blatantly misused despite recommendations to the contrary, and is now dangerously scarce for legitimate use.

I worry about the "14 day no refills" language though, and hope that doesn't prevent folks with rheumatologic diseases from getting their prescriptions refilled. I just started a new lupus patient on it the other week and he'll need it daily, perhaps for life (and yes, it's often lupus and House is an idiot who deservedly got kicked out of my alma mater).
A friend and her adult daughter are both on this for an autoimmune disorder (dunno if it is lupus specifically) - and they are very, very worried about having enough. One of them had run out and they were sharing the other prescription, hoping they would be able to get more before that ran out too.
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Old 03-25-2020, 06:47 PM
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Hey this is from another thread, from a long time ago, like 2 weeks.
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Originally Posted by Jim Peebles View Post
I think Vegas would be a bad vacation. But I am not changing any of my plans for coronavirus. I think it is an overblown run of the mill virus.
I asked you for a response there, but it looks like you aren't subscribed to that thread. So what do you think today about the overblown run of the mill virus?
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Old 03-25-2020, 07:06 PM
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I'm not worried about it, but one is considered a public health threat if one says that. I'm convinced the antimalarial drugs work (when combined with zinc and azithromycin), and on the off chance I get a serious case I would ask my doctor for it. I don't see how it is legal for a governor to tell doctors they cant give antimalarials to patients with serious cases of coronavirus.
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Old 03-26-2020, 03:19 AM
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Originally Posted by Qadgop the Mercotan View Post
It seems to me that's a mostly reasonable limitation to be enacted in a time of emergency on a regulated/prescription-only substance which has great medical use but is currently being blatantly misused despite recommendations to the contrary, and is now dangerously scarce for legitimate use.

I worry about the "14 day no refills" language though, and hope that doesn't prevent folks with rheumatologic diseases from getting their prescriptions refilled. I just started a new lupus patient on it the other week and he'll need it daily, perhaps for life (and yes, it's often lupus and House is an idiot who deservedly got kicked out of my alma mater).
I didn't find the Nevada declaration, but I saw discussion that it had a 31 day limit instead. No help if you're from another state, unless you're willing to drive interstate and the dispenser is willing to accept an out-of-state prescription.
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Old 03-25-2020, 05:32 PM
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Originally Posted by Jim Peebles View Post
From:
https://www.usnews.com/news/best-sta...virus-patients
"Sisolak [the Governor if Nevada] signed an emergency order earlier Tuesday barring the use of anti-malaria drugs for someone who has the coronavirus. The order restricting chloroquine and hydroxychloroquine came after President Donald Trump touted the medication as a treatment and falsely stated that the Food and Drug Administration had just approved the use of chloroquine to treat patients infected with coronavirus. Sisolak said in a statement that thereís no consensus among experts or Nevada doctors that the drugs can treat people with COVID-19."
Is this even legal? What about the "right to try" law? What about off label use of an FDA drug approved for something else? Is the Nevada Governor practicing medicine without a license? Can anyone harmed or whose family members are harmed from not being able to use the drugs to treat Covid-19 sue him? How can he be removed from office?
Shouldn't you prove that the drugs have any positive effect on coronavirus before you advocate using them? You can't, though. There is no proof.

And you are misunderstanding the "right to try" law.

Quote:
Right-to-try laws are U.S. state laws and a federal law that were created with the intent of allowing terminally ill patients access to experimental therapies (drugs, biologics, devices) that have completed Phase I testing but have not been approved by the Food and Drug Administration (FDA).
Basically, whenever you try to call for something that in your own cite says was "falsely stated " you're starting from deep in a hole.
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Old 03-25-2020, 05:51 PM
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Here and here are just two stories of people being unable to get their medications for Sjogren's and lupus because of shortages caused by hoarding. Several pharmacy boards have sent out notices to pharmacies not to fill prescriptions without a valid doctor patient relationship because so many doctors were writing prescriptions for themselves, friends and family. It's not an easy call. People with autoimmune diseases are presumably at higher risk for complications from Covid 19 especially since the alternatives to hydroxychloroquine are strong immunosuppressive medications. Word is that the local pharmacies are all out anyway.
Oh, and if this were the pit I would have some choice words about Kaiser in that second link telling a patient she would have to stop her plaquenil and thanking her for her sacrifice.
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Last edited by psychobunny; 03-25-2020 at 05:56 PM.
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Old 03-25-2020, 05:50 PM
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Those questioning the constitutionality or legality of emergency orders are welcome to file suit in appropriate courts. Have (m)any such suits been filed? What are the outcomes?
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Old 03-27-2020, 05:02 AM
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The use of Chloroquine/hydroxychloroquine as part of a treatment for SARS (caused by a different coronavirus than COVID-19) was tried in the earlier 2002-2004 SARS outbreak. In vitro testing showed apparent efficacy at glycosylation inhibition, helping to disrupt the viral replication process. Cite from The Lancet from 2006

Chloroquine shows strong anti-viral properties for both therapeutic and prophylactic roles.
Cite from 2005 from the Virology Journal: Chloroquine is a potent inhibitor of SARS coronavirus infection and spread from a study in primates cell cultures.

And so on. There is reasonable scientific reasons to think that Chloroquine/hydroxychloroquine may prove effective in treatment of the current coronavirus outbreak. While a fully blind study would be ideal, such may prove difficult in the current climate.
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Old 03-27-2020, 05:42 AM
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While a fully blind study would be ideal, such may prove difficult in the current climate.
Already been done, with no difference from placebo. Also underpowered though.
  #13  
Old 03-27-2020, 08:27 AM
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To put in succinctly, the much touted study was apparently a manipulated piece of crap, done by a doctor who appears to be as credible and professional as Trump’s personal physician. ETA - Does Trump shop for doctors at Grateful Dead concerts?

https://forbetterscience.com/2020/03...from-covid-19/

It was a 14 day study that, through some manipulation of time and space, was conducted in 10 days.
Peer review was done in less than 24 hours by an associate of the “scientist”.

Even though the stated endpoints were days 1, 7 and 14, the only data used was the day 6 data. This is called cherry-picking the endpoints and it’s a common way to cheat in drug trials.

Here’s how it works. You are testing a drug. You have a heavily tested interest in the drug being successful. Yiu design a test with a 14 day endpoint. You give the drugs to a bunch of patients for two weeks and the results at the end of two weeks are minimal or non-existent. But you tested every patient every day. So at the end of the two weeks you comb through the data and find that many of your patients improved a little bit on Day 9, even if it didn’t stick.
So your published result is “promising new drug shows results after 9 days”.

The patient groups also appeared to be cherry-picked and the control group was, on the average, about 15 years older than the group that got the drug. Plus, they weren’t treated at the same location and they were tested using different methods. And they declined to release certain clinical results (whether the patient got better), releasing only viral load data.

Their main concern seemed to be getting these results to Fox News. And that Trump sucking asshat Dr. Oz actually went on national TV with the opinion that this doctor was a great genius and it would be unethical not to give these drugs to millions of people.

It’s really mind-boggling stupidity, and very harmful to people that have conditions that these drugs actually work against.

Last edited by Ann Hedonia; 03-27-2020 at 08:31 AM.
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Old 03-27-2020, 09:37 AM
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A good way to boost your reported success rate is to remove people from the treatment group if they get sent to the ICU or if they die.
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Old 03-27-2020, 10:58 AM
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"Junk science" is unfortunately a real thing, and there is no field in which it's as prevalent as medicine.

I wrote the first major books about lactose intolerance. To do so I spent endless hours in the basement of the med school library, where the old medical journals were stored, reading literally every study every published about the problem that they had available.

I'm not a doctor, but I did go as far as grad school statistics and worked professionally in survey research (FORTRAN on punch cards!), so I had a basic understanding of how to conduct a study and meaningfully process the results.

Out of all the hundreds of peer-reviewed journal articles I read, shockingly few gave information that was useful to me in advising people about how LI worked and what to do if you had it. The vast majority were quickie, small-scale studies done for apparently no reason other than to get something published and move on to the next quickie, small-scale study. Most did no more than gather a group small enough to fit in a room, feed them some lactose, and have them self-report symptoms.

There is a much quoted line that reads "At least one study found that the average academic article is read by about 10 people, and half of these articles are never read at all." Ironically, that statement itself is junk. Trying to trace it back led to an editor at a journal who inserted it into somebody else's article based on a memory of something he heard in college. I found another unsourced claim that 44% of all articles are never cited. That one I can believe.

What happened here was that people suddenly raced back to the literature to find anything that might possibly be useful, with the result that old junk that never should have been unearthed hit the media. It's still junk, though. This is a good lesson for anyone willing to pay attention.
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Old 03-27-2020, 11:43 AM
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Isn't this practice done all of the time? Oh, yes it is: https://en.wikipedia.org/wiki/Off-label_use

So could someone with medical expertise convince me that this just isn't a middle finger to Trump? Sure, maybe it does not work, but could it be harmful? Any more harmful than side effects of other medications?

As long as my doctor gives me the full information as to the possible negatives, why shouldn't I be able to take it with the blessing of my doctor?
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Old 03-27-2020, 12:07 PM
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Isn't this practice done all of the time? Oh, yes it is: https://en.wikipedia.org/wiki/Off-label_use

So could someone with medical expertise convince me that this just isn't a middle finger to Trump? Sure, maybe it does not work, but could it be harmful? Any more harmful than side effects of other medications?

As long as my doctor gives me the full information as to the possible negatives, why shouldn't I be able to take it with the blessing of my doctor?
It has extremely severe side effects, including blindness. It is just as extremely unethical to prescribe a medication for off-label use which has exactly zero proof that it is in any way effective but would certainly hurt many patients needlessly.
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Old 03-27-2020, 12:47 PM
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It has extremely severe side effects, including blindness. It is just as extremely unethical to prescribe a medication for off-label use which has exactly zero proof that it is in any way effective but would certainly hurt many patients needlessly.
Then why would any doctor give it to a patient to treat Covid-19?

I have no medical training and therefore no opinion whatsoever about the efficacy of these drugs. Are some suggesting that my doctor might be such a MAGA Trump supporter that he would risk my life for no medical benefit because Trump said so?

If so, he would just be hurting Trump by having me go blind and not helping my illness would he not?
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Old 03-27-2020, 12:50 PM
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Then why would any doctor give it to a patient to treat Covid-19?
WAG: Some doctors wouldn't, but some would just because the patient demanded it. Just like some doctors will prescribe antibiotics for a cold or flu because patients insist on them.
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Old 03-27-2020, 03:55 PM
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WAG: Some doctors wouldn't, but some would just because the patient demanded it. Just like some doctors will prescribe antibiotics for a cold or flu because patients insist on them.
I've evaluated and supervised my fellow doctors for decades.

Some of them just can't say no to patient requests. They're people pleasers who wilt under pressure. And it's difficult to break them of that character defect. I know, I've tried. It's ridiculous, but there it is. It takes close scrutiny and constant supervision to have a chance at changing some of them.
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Old 03-27-2020, 01:53 PM
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Then why would any doctor give it to a patient to treat Covid-19?

I have no medical training and therefore no opinion whatsoever about the efficacy of these drugs. Are some suggesting that my doctor might be such a MAGA Trump supporter that he would risk my life for no medical benefit because Trump said so?

If so, he would just be hurting Trump by having me go blind and not helping my illness would he not?
There is no free market solution to prescribing medications. Take anything for any reason is not medicine but quackary.

Are some doctors quacks? Certainly. Since you now know better, if your doctor suggests this medication run out the door and contact your state medical association.
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Old 03-27-2020, 12:29 PM
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Isn't this practice done all of the time? Oh, yes it is: https://en.wikipedia.org/wiki/Off-label_use

So could someone with medical expertise convince me that this just isn't a middle finger to Trump? Sure, maybe it does not work, but could it be harmful? Any more harmful than side effects of other medications?

As long as my doctor gives me the full information as to the possible negatives, why shouldn't I be able to take it with the blessing of my doctor?
Off-label use happens all the time, yes. In many cases itís still a shady practice, simply because frequently the drug is used off-label because it couldnít pass the clinical trial for the condition.

Sometimes itís not a shady practice. Frequently a drug found effective against one type of solid tumor cancer will be used off-label for other similar solid tumor cancers. Because thereís a pretty good case that these tumors respond similarly to similar medications. Myself, I occasionally take a prescription antihistamine off-label for anxiety.

But there are strict laws against the drug companies PROMOTING these drugs for off-label use. The pharmaceutical companies employ or pay doctors to promote off-label uses of medication to other doctors. They also frequently ghost write articles for medical journals and pay doctors to put their name on them. I find this to be a shady practice although pharmaceutical companies have their own talking points justifying such practices.

Iím not sure about the legality of an untrained person who happens to be the President of the United States promoting a virtually untested drug to millions of people. Probably one of those laws we donít have because no one thought we needed it. I think itís immoral, though.

The biggest issue in this case isnít the practice of off-label prescribing.

Itís that the one preliminary study appears to be garbage.

Last edited by Ann Hedonia; 03-27-2020 at 12:32 PM.
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Old 03-27-2020, 07:25 PM
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I'm a bit disturbed by governors who apparently know so much about medicine that they overrule doctors.
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Old Yesterday, 04:53 PM
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There is a massive conspiracy by the French government and BIG PHARMA to suppress this cheap miracle cure and discredit the brilliant Dr. Raoult.

https://asiatimes.com/2020/03/why-fr...ed-virus-cure/
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