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Message
re: Great news! Azithromycin & Chloroquine: victory lap
Posted on 3/21/20 at 9:22 am to Hopeful Doc
Posted on 3/21/20 at 9:22 am to Hopeful Doc
I just want to chime in that I am also an MD, and I fully agree with your assertions. I am glad you are taking the lead on this, because there is no worse place for irrational thinking than here.
The study is promising. But I hope better studies confirm the findings and demonstrate good clinical outcomes. But if this study were the standard of all studies, we would have no evidence based medicine to rely on.
The study is promising. But I hope better studies confirm the findings and demonstrate good clinical outcomes. But if this study were the standard of all studies, we would have no evidence based medicine to rely on.
1
Posted on 3/21/20 at 9:23 am to Eli Goldfinger
Geaux for the Cure!!
Posted on 3/21/20 at 9:25 am to Eli Goldfinger
So an antimalarial and an antibacterial will save us from a VIRUS? OK. I am officially dropping my pharmacist credentials and jumping on board.
Posted on 3/21/20 at 9:27 am to Hopeful Doc
quote:
I disagree. I have seen no outcome data for it, and I have looked. Reducing secretion in a nasal swab in an unknown degree of sick patient isn't really useful to me. I won't base treatment decisions off of that.
There isn’t much data to look at. Even if you looked at every severe case in our country, there wouldn’t be enough.
However, there is enough data that health organizations are being encouraged to move forward with the combo as the most effective - CURRENTLY KNOWN AND WIDELY AVAILABLE - treatment by higher ups.
Posted on 3/21/20 at 9:29 am to Eli Goldfinger
Trump just tweeted about this btw. If you want to add to your op
Posted on 3/21/20 at 9:32 am to AndyJ
quote:
I just want to chime in that I am also an MD, and I fully agree with your assertions
Fight the good fight, brother.
quote:
. I am glad you are taking the lead on this
I don't try to speak with authority on here. I try to share my perspective and thoughts of those around me from the lounge. I really enjoy when other docs or folks with moderate-to-high level science backgrounds post on subjects. It's always fun to hear what those like you think- especially, for me, when we disagree
Posted on 3/21/20 at 9:36 am to Eli Goldfinger
quote:
Even if you looked at every severe case in our country, there wouldn’t be enough.
Look, I'd be happy with a retrospective review of 100 who got it and 100 who didn't.
I'd like to see a small group in the ICU (50 would be plenty) where half get it and half don't with someone doing a little bit of matching
I don't care about IRB approval and proper NEJM-level multi-year million dollar studies.
I just think the limited data we have is basically as useful as the guy next to me in the lounge saying, "hey. I gave my COVID patient steroids and NSAIDs and they lived"
quote:
However, there is enough data that health organizations are being encouraged to move forward with the combo as the most effective - CURRENTLY KNOWN AND WIDELY AVAILABLE - treatment by higher ups.
I think we agree more than we disagree. I'm sorry that I mischaracterized what you said earlier. It wasn't intentional.
Posted on 3/21/20 at 9:41 am to Eli Goldfinger
The problem with moving forward with unproven treatment is that it might prevent us from adequately studying it further. Basically, we will not have a control group to compare our treatment group with (if everyone is in the treatment group). Because there are times when we are enthusiastic about a treatment... then after further study, it turns out it is not helpful. Unfortunately, there are times when our treatment is even harmful.
This post was edited on 3/21/20 at 9:41 am
Posted on 3/21/20 at 9:41 am to Hopeful Doc
quote:Outstanding post!! Thanks for the background.
Hopeful Doc
This post was edited on 3/21/20 at 9:42 am
Posted on 3/21/20 at 9:45 am to thelawnwranglers
quote:
Did Oprah get arrested yet though?
I'd trade another two weeks of quarantine to see this happen
Posted on 3/21/20 at 9:49 am to rphtx
Oh no, you should alert the epidemiologists and let them know their trials are bullshite.
Posted on 3/21/20 at 9:50 am to SOKAL
Posted on 3/21/20 at 9:56 am to AndyJ
quote:
Unfortunately, there are times when our treatment is even harmful.
For the MDs in here...based on what we(you) know,would you prescribe this cocktail and hope for a cure? Or, would you be fearful of bad outcomes?
Posted on 3/21/20 at 9:57 am to AndyJ
quote:
Basically, we will not have a control group to compare our treatment group with (if everyone is in the treatment group).
I would imagine it'd be really tough to get someone circling the drain to volunteer for the control group at this point.
quote:
Unfortunately, there are times when our treatment is even harmful.
I would understand this with a new drug that hasn't been used before, but the proposed treatements have seen widespread use for years (admittedly for malaria, but still its seen widespread use).
This post was edited on 3/21/20 at 9:59 am
Posted on 3/21/20 at 9:58 am to Tecate
Honestly, for a very sick family member I probably would. But I would do so knowing that I was doing so based on emotion rather than science. I am human.
And stop asking the tough questions haha
And stop asking the tough questions haha
This post was edited on 3/21/20 at 10:03 am
Posted on 3/21/20 at 10:02 am to LSU0358
Your points are good. And I do not mean the harm would come from side effects from the medications (other than something called prolonging the QT interval). I mean specifically, it could turn out that that fighting the body’s inflammation (which is something hydroxychloroquine does), could end up being harmful. Or perhaps it is helpful for the very sick but harmful in people with mild disease. Or moderate disease. Or it could be good for healthy people but bad for diabetics. Or possibly bad for people who take certain medications. That’s the sort of thing we are missing
Posted on 3/21/20 at 10:04 am to Eli Goldfinger
So help me understand the hang up some of you are having with the study linked?
Is it just that you are holding out the possibility that all the people who took the drug combo were “cured” was a coincidence? Or is it you think that they were not actually “cured” and the data suggest they were is incorrect?
I realize the “cured” may not be the right term here so forgive me.
Is it just that you are holding out the possibility that all the people who took the drug combo were “cured” was a coincidence? Or is it you think that they were not actually “cured” and the data suggest they were is incorrect?
I realize the “cured” may not be the right term here so forgive me.
Posted on 3/21/20 at 10:11 am to Robin Masters
Look, the study is promising. And I am hopeful. But there are thousands of studies that come out per year. And one of that quality would never even get propped up as anything more than, “larger, better studies needed.” It reminds me of Drudge (who I used to like) would a few times per year saying “cancer cured in rats.” This has been ongoing 10 years, and none have gone anywhere.
This quoted study is so small. For all we know the treatment and control groups might not have been adequately randomized. Let’s say I wanted to study Splenda for covid 19. So I gave it to 20 patients with mild illness and did nothing for 20 patients with moderate illness. Afterwards the Splenda patients did better than the control group. Was it because of the Splenda or because the control group was sicker to start with. That’s just an example of why some studies are better than others
This quoted study is so small. For all we know the treatment and control groups might not have been adequately randomized. Let’s say I wanted to study Splenda for covid 19. So I gave it to 20 patients with mild illness and did nothing for 20 patients with moderate illness. Afterwards the Splenda patients did better than the control group. Was it because of the Splenda or because the control group was sicker to start with. That’s just an example of why some studies are better than others
Posted on 3/21/20 at 10:12 am to AndyJ
quote:
mean specifically, it could turn out that that fighting the body’s inflammation (which is something hydroxychloroquine does), could end up being harmful. Or perhaps it is helpful for the very sick but harmful in people with mild disease. Or moderate disease. Or it could be good for healthy people but bad for diabetics. Or possibly bad for people who take certain medications. That’s the sort of thing we are missing
All good points. Going to have to weigh harm to some or death to many.
Or not give this treatment until people start to have lung issues. That step alone would eliminate a large % of the infected from being candidates for the treatment.
It'll unfortunately be a statistics game with some folks on the far end of the curve potentially getting screwed. I know its easy balk at this when thinking about individuals, but in a pandemic the decision makers have to put the individual behind the whole population.
Posted on 3/21/20 at 10:16 am to AndyJ
quote:
And stop asking the tough questions
Aren't those the most important ones?
Oh,...and thanks.
This post was edited on 3/21/20 at 10:17 am
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