The International Society of Antimicrobial Chemotherapy (in whose journal the French study was published) have issued a statement that says in part “the article does not meet the Society’s expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety.”
His political base doesn’t need revving up. They will be plenty revved up already. An extra enthusiastic vote is still just a vote. The question is peeling away swing voters and centrist democrats. Nobody is going to be talking about Hydroxychoroquine in November, especially if it is just some mediocre thing. If it was a miracle drug that would be known by now. This is gonna be steamrolled by literally dozens of other things between now and November.
What, imo, would push him over the top, and looks might happen, is they are continually pushing the projected death tolls down by the 10s of thousands as the days go by. Considering the initial Imperial College projections for US deaths were in the millions, if this get pushed down to flu-like numbers (say, 80Kish), which looks possible and is hopefully true from a non-partisan standpoint, he’s going to be able to put that down as a win no matter how democrats spin it.
In the world of drug research, to criticize a study for its failure to ensure patient safety is about the worst thing you can say about it.
Let’s say the study did recklessly endanger patients’ lives. But if the drug still worked are we supposed to ignore that information? I mean sure, punish the experimenters for their allegedly irresponsible acts, but why punish the rest of us?
Not necessarily, but the part about “lack of better explanations of the inclusion criteria” means that the journal’s board is suspicious that the data showing it worked was manipulated, and that the study didn’t really demonstrate it working in the first place. If the experimenters were playing fast and loose with both the ethics and the data, yes, you should ignore the information because you can’t trust the information.
I think this is most effective if coreopsis has set in
And yet the government is stockpiling tens of millions of doses of the stuff. Gee, I wonder who is benefiting financially from that. . .
It’s no wonder to me why Trump has gone all in on hydroxychloroquine. If he’s wrong, that would mean we the tax-payer has bought 29 million pills of uselessness. So he can’t be wrong.
Lord, please don’t let him be wrong!
India agrees to release Chloroquine stocks, fearing US retaliation
This is a mighty victory for America. You all ought to be grateful to the Chief.
Just don’t blame us if the pills don’t work against Covid.
I’m not an expert on anti-virals, but according to wikipedia there have been 5 studies suggesting that chloroquine has antiviral properties, with mechanisms that make sense to me.
I’m not for a moment suggesting chloroquine is an effective treatment for this virus, or most viruses, and I agree Trump has been irresponsibly acting like a snake-oil salesman on this, but it appears incorrect to categorically say that chloroquine has no antiviral properties.
Also for the record, the antiviral mechanism of chloroquine has absolutely nothing to do with how it works as an anti-malarial. Coronavirus has no broad relationship with malaria or anti-malarial drugs.
Does the FDA approve things that aren’t “scientifically helpful?” Will you admit that falsely saying that it was FDA approved was the same thing as saying that it’s scientifically helpful?
Given CP and Hydroxychloroquine’s suspected mechanism of action (preventing glycosylation at the ACE-2 receptor), they’re lack of efficacy with flu is meaningless. I don’t know where you’re getting the idea there is no evidence. There are a number of controlled studies, however small and flawed, that show efficacy. The studies that show no efficacy are embarrassingly bad. Doctors everywhere are prescribing it. Frontline healthcare workers in NYC are using it prophylactically. My friend who is head of infectious diseases at St Michaels in Newark, who is Spockian in his dispassionate analysis, says it’s an unequivocal success (as do most of his colleagues) in his clinic, and the lack of success other Drs see is likely a result of waiting until it’s too late (which is very clear in the study I referenced in the OP). None of this is to say that the drug works, but your insistence that it doesn’t is as ungrounded in science as your criticisms of the pro case.
And advertising drugs doesn’t work to increase drug sales, which is why we never see those even though it’s legal.
It’s important to note here that the outcome has nothing to do with whether chloroquine works. Even if it proves to be an utter failure, Trump supporters will claim that the media is suppressing information on chloroquine successes. They will direct us to YouTube videos of one person claimed they were cured by chloroquine.
The media’s error was not how they covered chloroquine. The media’s error is engaging with Trump at all. He’s a parasite that feeds off their attention, and they need to stop giving it to him. They shouldn’t cover his medical or scientific opinions any more than they would any other failed real-estate investor or corrupt politician.
How is he establishing unequivocal success? If he’s giving it to many patients early in the disease process, well, most people with mild to moderate cases are going to recover anyway, so how is he establishing who is recovering BECAUSE of it, versus who is recovering COINCIDENTAL with it?
If this stuff works, then that’s great news, but let’s make sure we are measuring what we think we are measuring.
It does have some anti-viral effects. It will kill off most viruses in a test tube or Petri dish (in vitro). But it has never been shown to be effective in vivo -inside a living organism. This is a trajectory frequently seen with early “promising” research that doesn’t pan out.
My issue with the press coverage of these drugs is they are making it sound like a new idea. They are not mentioning that these drugs have been tested as treatments for similar viruses - like the flu - for many years and they have never been proven to be effective as a treatment for any viral infection in humans.
I apologize if I wasn’t clear about this when I claimed the drug has never been shown to be an effective anti-viral. I meant effective as medicine for viral infections in living beings, not that the substance had no anti-viral properties whatsoever.
I think what may happen - I say ‘may’ b/c we just don’t have enough evidence - is that we may see exactly what we’re seeing and hearing about now: success that is inconsistent across the population but perhaps effective in isolated situations. If this were adhering to the usual FDA process, the combination probably wouldn’t pass muster, which is what the Dr. Faucis of the world are arguing. But when you’re desperate, in individuals cases, it could prove to be beneficial.
If this is an accurate summation of the situation then the best Trump could do is point out that this might work in a few cases and that production will be ramped up to make sure there’s an adequate supply of it, but he should really avoid hyping this up as a cure, as it seems highly unlikely that this will help cure a majority of cases that end up in ICU care.
“I think the media is setting up Trump for a big win on Hydroxychloroquine” @op
- Those who call it snake oil are to blame.
- Those who criticize Trump for making HCQ and the possibilities known by everyone are to blame…
Democrats are playing into the hands of Trump.
I think the hydrochloroquine data are being mis-represented in every conceivable direction right now, and it’s bad. I guess the real truth – nobody knows anything yet, pro or con – just doesn’t satisfy?
I mean, chloroquine is active against the novel coronavirus responsible for COVID-19 in vitro (Wang et al. Cell Research 2020;30:269-271 and elsewhere). It’s obviously true that this doesn’t necessarily translate to clinical benefit – the drug has shown in vitro antiviral activity in a number of instances over the last 20 years and it hasn’t ever panned out clinically – but it’s irresponsible to characterize this as some kind of out-of-thin-air thing. The nonclinical research absolutely justifies (cautious, measured) evaluation of the drug in infected patients, especially given the seriousness of the outbreak.
OK, so the clinical study that started all this is a French study, which was published in March (Gautret et al. Int J Antimicrob Agents 2020;20 March (E-pub ahead of print). A total of 42 patients met entry criteria (basically, age >12 and documented infection with SARS-CoV-2); 26 were treated with HCQ and 16 were not (there’s a bit of added complexity here because some patients received HCQ+azithromycin and some received HCQ only, but I’m going to ignore this for now). Of these 42, 6 – all HCQ patients- were lost to follow-up because treatment was stopped early – three due to transfer to ICU, one due to death, one due to toxicity, and one patient whose disease resolved quickly who was released from the hospital. The authors chose to consider results only from the 20 HCQ patients who received a full course of treatment. This is obviously a poor and self-serving choice – if a patient died on the drug or had to stop taking it due to toxicity, you can’t just throw those results away! – but we’ll come back to that later.
OK, so we’re left with 20 patients who received a full course of HCQ and 16 patients who received best available care. Ay Day 3, 10 of 20 (50%) of the former and 1/16 (6.3%) of the latter were negative for infection. The corresponding figures at Day 6 were 14 of 20 (70.0%) and 2 of 16 (12.5%), respectively. Of note, 6/6 patients treated with HCQ+azithromycin were negative for infection by Day 5.
That looks great! But! There’s still those 6 patients HCQ who were excluded from the analysis. To be as conservative as possible, let’s consider all six would have been treatment failures. This results in a response rate at Day 6 of 53.8% (14 of 26 HCQ-treated patients) - still much better than the 12.5% seen with the control.
That’s still good! But! Of those 12 control patients, who did not received HCQ, FIVE did not have their viral loads tested at all on Day 6 (many patients on both arms did not have actual viral loads reported, just simple “positive” or “negative” results, which is its own kind of problem but let’s let that go for today). So – again, being as conservative as possible – let’s assume that all five of those control patients would have been negative for the virus on Day 6. This would have meant that 7/12 control patients were negative on Day 6; that’s 58.3% - a better percentage than associated with HCQ when those missing 6 patients are considered!
Now, of course it’s exceedingly unlikely that all five control patients without Day 6 results were actually negative. Three of those five had been positive on Day 5, and none had ever had a non-positive result. And at least 1 of the 6 “missing” HCQ patients probably can be considered a positive outcome. So in the end the actual figures probably favor HCQ (and especially, favor HCQ+azithromycin). But not by as enormous a margin as has been reported.
So why did I go into so much detail here, probably boring most of you out of the thread? Because interpretation of this study is complicated. It’s not as simple as “good study” versus “bad study,” and saying that there is no evidence whatsoever that HCQ may be active against this idea is almost as irresponsible as calling it a miracle cure. We don’t know. This drug might help and it might not, but we don’t know. The evidence meets the standard for further study, and that is the most conclusive thing anyone can say; don’t trust anyone who goes further than that in either direction, because, and I can’t say this often enough, they don’t know.
P.S. Just to show that there’s weird science going on everywhere right now, Chinese researchers just reported that HCQ did not produce any benefit versus control in a 30-patient trial. Except that the majority of the patients in the control arm received other experimental treatments (mostly antivirals!), so the value of the results is questionable here, too.