@sonhouse saidPutting aside Trump (his bluster has no impact on the effectiveness or risk of the drug, though people have an awful lot of trouble remembering that), there are a few points that have to be made:
https://www.tigerdroppings.com/rant/politics/96000-patient-study-shows-hydroxychloroquine-increased-risk-of-death/90102945/
Bottom line, NO GOOD. 400% increase in cardiac arrhythmia and more.
Take this crap at your own risk.
1. This was not a RCT but a retrospective analysis. As in the VA case, it's quite likely the people who were given HCQ were more sick, on average, than those who were not. This is common sense. People are more likely to prescribe and seek unproven treatments when they're more desperate.
2. Something about all this new evidence about how dangerous hydroxychloroquine is makes no sense. This drug has been taken routinely by people for many decades without much in the way of an increased risk profile. Most likely, the drug does have some minute association with adverse heart outcomes, but those are amplified in these analyses because people likely to be very sick with COVID (and thus likely to take it) are disproportionately very old and/or with significant cardiovascular problems.
3. The assertion that "Past studies also found scant or no evidence of hydroxychloroquine’s benefit in treating sick patients" is plain false.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162746/
https://www.medrxiv.org/content/10.1101/2020.05.13.20094193v1.full.pdf
https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1.full.pdf
https://www.preprints.org/manuscript/202005.0057/v2
https://www.sciencedirect.com/science/article/pii/S1477893920302179
Less direct measured correlating the fatality rates of regions and countries that have and have not adopted HCQ-based treatments also may imply effectiveness.
It's also the single most commonly prescribed treatment in the world, and if you think that's ALL because of Trump, you're delusional.
https://www.sermo.com/press-releases/[WORD TOO LONG]/
The hundreds of thousands or millions of doctors who are prescribing it may be wrong, but they're not all a bunch of simpletons who are incapable of reading the Washington Post.
It's amusing that retrospective analyses showing HCQ is effective are always dismissed as anecdotal or not up to scientific standards, while retrospective analyses showing HCQ is ineffective or dangerous (like the article cited in the OP) are heralded as the final word.
Now, I'll grant that the record is very mixed on HCQ and I don't think it's smart to take it as prophylaxis (especially if you have heart issues), but there hasn't been a single RCT where the full cocktail has been administered early in the disease (though rumor has it that the UMN study is wrapping up, so we may be hearing from it soon).
There's no need to really guess on this or to let politics cloud one's judgment. We'll soon know - certainly within the next three months many of the RCT will report results and we won't have to resort to loaded restrospective analyses full of confounding variables.
In the interim, it's a balancing test, risk vs. reward, that should be made by each doctor/patient, not by Donald Trump (except insofar as himself is concerned) and certainly not by keyboard warriors rooting for anything associated with Trump to fail.
22 May 20
@sh76 saidIt is possible that the drug specifically interacts with COVID in such a way as to cause death.
Putting aside Trump (his bluster has no impact on the effectiveness or risk of the drug, though people have an awful lot of trouble remembering that), there are a few points that have to be made:
1. This was not a RCT but a retrospective analysis. As in the VA case, it's quite likely the people who were given HCQ were more sick, on average, than those who were not. This is co ...[text shortened]... oncerned) and certainly not by keyboard warriors rooting for anything associated with Trump to fail.
22 May 20
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@athousandyoung saidYes, that is possible, especially since COVID seems to target the cardiovascular system as much as the pulmonary system.
It is possible that the drug specifically interacts with COVID in such a way as to cause death.
But that kind of correlation can never be proven outside of a clinical trial - certainly not be a retrospective analysis of death rates.
22 May 20
@techsouth saidThank you. I'm not worried about being mocked.
@sh76
Great write up, more carefully thought out than typical on social media.
Prepare to be mocked by those that prefer flippant dismissal of anything that challenges their world view.
Today's study was bad (especially because of the large sample size), but a randomized control trial of early administration will tell the story, not retrospective studies of cases where the administration of the drug were done almost blindly.
A good indication may be from this study:
https://covidpep.umn.edu/updates
And the Twitter page of the person running the study:
https://twitter.com/boulware_dr?lang=en
It seems like the study is concluded and they're gathering data, writing it up and waiting for peer review. If it turns out badly, I'll be almost ready to give up. If it turns out well, I'm back on the bandwagon.
22 May 20
@sh76 saidI ignored the blog post (or whatever it was linked to in the OP) and the Washington Post story and went straight for the Lancet article (link below).
Putting aside Trump (his bluster has no impact on the effectiveness or risk of the drug, though people have an awful lot of trouble remembering that), there are a few points that have to be made:
1. This was not a RCT but a retrospective analysis. As in the VA case, it's quite likely the people who were given HCQ were more sick, on average, than those who were not. This is co ...[text shortened]... oncerned) and certainly not by keyboard warriors rooting for anything associated with Trump to fail.
In the absence of an RCT it's the best evidence available, and qualifies as at least moderate quality evidence. That 96,000 figure is misleading since they had a huge control group. The control group had 81,144 patients and the largest treatment group only 6,221, the combined treatment groups contained 14,888 patients - so the effective size of the study is something between 20,000 and 30,000. Given the size of the study it probably qualifies as high quality evidence.
The study authors did their work and ensured that there were no significant differences between groups. They also excluded patients who had been prescribed hydroxychloroquine after ventilation. They calculated Cox hazard ratios that controlled for all the independent risk factors, such as age, BMI, and so forth. In short, I'm not seeing any red flags in the write up. Which is quite a nice one, they said the stuff I was looking for really clearly.
There is moderate to high quality evidence that hydroxychloroquine causes increased mortality in covid-19 patients. If the RCTs find a different result then that would tend to be overriding evidence.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext
22 May 20
@sh76
Thanks for the analysis. Keyboard warriors, Good one🙂 I am agnostic on this, just want the truth.
But I'll say this: My sister and mother are both Trumpites.
And I called her the other day and asked her about HCQ and she said, I don't have so I won't take it. BUT She said ( I assume because Trump said to use it) that she WOULD use it if she got sick.
Considering her source of news is basically 100% Fox, then it is because of Trump she would consider it.
22 May 20
@sh76 saidsh76, good posts. just as an aside, I know woman with lupus and has used HQ for a long while, decades.
By the way, for all the people screaming about how dangerous hydroxychloroquine is (after 7 decades of use), are they suddenly going to stop prescribing it for Lupus or for Malaria prophylaxis.
When that happens, I'll believe that the medical community really thinks it's dangerous.
The democrats don't give this drug one ounce of consideration. All the dems know is, if it gives people just a glimmer of hope, they will take out their Maxwell Silver Hammers and smash it into a thousand pieces.
They want Americans to die, the want total economic blight.
The People's Fear and Intimidation Movement rolls on.
22 May 20
@deepthought saidThere is moderate to high quality evidence that hydroxychloroquine causes increased mortality in covid-19 patients.
I ignored the blog post (or whatever it was linked to in the OP) and the Washington Post story and went straight for the Lancet article (link below).
In the absence of an RCT it's the best evidence available, and qualifies as at least moderate quality evidence. That 96,000 figure is misleading since they had a huge control group. The control group had 81,144 patients ...[text shortened]... ing evidence.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext
=== Would you agree that this can be changed to "hospitalized covid-19 patients"?
Given that antivirals (like Tamiflu) typically work best early in the course of the disease (I'm no doctor, but I've been told by doctors not to bother with Tamiflu if you don't start taking it within 2-3 days of symptoms onset), wouldn't the study be beside the point if you're testing the drug as a potential antiviral treatment?
22 May 20
@earl-of-trumps saidWe don't want Americans to die. We just want numbskulls like you to shut up.
The democrats don't give this drug one ounce of consideration. All the dems know is, if it gives people just a glimmer of hope, they will take out their Maxwell Silver Hammers and smash it into a thousand pieces.
They want Americans to die, the want total economic blight.
The People's Fear and Intimidation Movement rolls on.
22 May 20
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@sonhouse saidThank you. And I'm humble enough to defer to DT, as he's more familiar with these things than I am.
@sh76
Thanks for the analysis. Keyboard warriors, Good one🙂 I am agnostic on this, just want the truth.
But I'll say this: My sister and mother are both Trumpites.
And I called her the other day and asked her about HCQ and she said, I don't have so I won't take it. BUT She said ( I assume because Trump said to use it) that she WOULD use it if she got sick.
Considering her source of news is basically 100% Fox, then it is because of Trump she would consider it.
In all honesty, my hope for something good out of HCQ is waning; probably down to about a 20 on a scale of 100, but I'm waiting for the RCTs before I throw in the towel.
It also bothers me that media outlets like WaPo and CNN seem to be actively rooting against it.
22 May 20
@sonhouse
As far as I'm aware, the jury isn't out yet. There's a legitimate chance that it could be a useful drug to fight COVID-19. The problem isn't necessarily with the drug, it's more to do with Trump throwing caution to the wind and telling his supporters "What are you waiting for? Take it!"
Regardless of how irresponsible Trump is being, that doesn't necessarily mean the drug is dangerous. In fact, since there is a possibility the drug *might* be beneficial, Democrats are doing a huge disservice by reflexively attacking any use of it simply because Trump lauds it. If the drug proves useful, potential lives that could be saved may due to bad press given by Dems. Give the drug time.
Yes, Trump is a dumbass who doesn't think things through, especially regarding a drug that's potentially more dangerous to his age group. Give the research time and let scientists come to a conclusion. Otherwise, it's possible Democrats could unwittingly be the reason a potential treatment doesn't get made.