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re: NY HCQ study is a joke. We are being lied to
Posted on 5/13/20 at 9:41 am to Taxing Authority
Posted on 5/13/20 at 9:41 am to Taxing Authority
quote:
But observational doesn't mean you have no choice about who is included.
But you have no choice with regards to who was treated. If the distribution of treatment is heavily skewed towards those with or without a given condition, that’s just the way it is. You just have to make eye and acknowledge the limitations, which they did.
1
Posted on 5/13/20 at 9:41 am to TigerWoodlands
quote:
does it matter if it's well managed hypertension vs unmanaged hypertension?
I can't answer this for certain, but most analyses that I have read simply correlate a history of hypertension and don't segregate "controlled vs. uncontrolled"
Posted on 5/13/20 at 9:42 am to shell01
quote:
So they looked at 1446 patients who came in
They ended up excluding some of them because they were intubated, died, or were discharged in a short period of time after showing up.
Posted on 5/13/20 at 9:42 am to dewster
quote:
I'm not a doctor, but can we assume that intubation occurs in this case because a ventilator is being deployed? If so, it may as well be death.
that's not what the study actually found.
out of the primary outcomes, 60% of the hcq were deaths and 89% of the control group were deaths, which means more people were getting intubated and then surviving in the hcq group.
Posted on 5/13/20 at 9:44 am to Tiguar
quote:
out of the primary outcomes, 60% of the hcq were deaths and 89% of the control group were deaths, which means more people were getting intubated and then surviving in the hcq group.
And the HCQ group were in more dire straits to begin with.
Posted on 5/13/20 at 9:44 am to Bass Tiger
quote:
I’ve listened to no less than a dozen doctors on television, YouTube, talk radio say HCQ is an effective therapeutic for Covid19 if administered before the patient is ready for a ventilator. The VA study was flawed from the get go because most patients were already deathly ill.
The VA population diverges so greatly from the general populace that it’s always tough to extrapolate data from there to medicine as a whole.
Posted on 5/13/20 at 9:45 am to Tiguar
quote:
Even with these disparities, if you isolate "death" from the primary outcome, 60% of patients in the hcq primary outcome group died vs. 89% of the control.
Interesting.
Has anyone crunched the hard numbers to determine if this is a statistically significant difference?
Posted on 5/13/20 at 9:46 am to onmymedicalgrind
I didn't check it, but someone posted a graphic on another board that showed the 99% confidence intervals didnt even come close to touching. but that math could be wrong
Posted on 5/13/20 at 9:47 am to Tiguar
quote:
out of the primary outcomes, 60% of the hcq were deaths and 89% of the control group were deaths, which means more people were getting intubated and then surviving in the hcq group.
If true, that's an interesting find.
I'd just like to see hard evidence that this treatment works, although I don't see an issue if doctors want to prescribe it as a last resort. I certainly think that Michigan banning it for a while was needlessly partisan at best.
Posted on 5/13/20 at 9:49 am to Sasquatch Smash
quote:
They ended up excluding some of them because they were intubated, died, or were discharged in a short period of time after showing up.
Correct, they censored 70 patients "...who were intubated, who died, or who were transferred to another facility within 24 hours after presentation to the emergency department"
Posted on 5/13/20 at 9:49 am to dewster
quote:
although I don't see an issue if doctors want to prescribe it as a last resort.
the issue is it won't work if you use it like this
there is this tendency is medicine to get more liberal with "off label" voodoo therapies as patient condition declines as it shields you from litigation of your judgement, but with the way this works if you wait that long, it's pointless
Posted on 5/13/20 at 9:50 am to onmymedicalgrind
quote:
Interesting.
Has anyone crunched the hard numbers to determine if this is a statistically significant difference?
We scientist likely put too much faith in statistical significance.
If those percentage numbers play out the same or similarly as you increase your population yet they aren't statistically different by the test, wouldn't you still want the outcome that's 29% better?
Posted on 5/13/20 at 9:51 am to Tiguar
quote:
out of the primary outcomes, 60% of the hcq were deaths and 89% of the control group were deaths, which means more people were getting intubated and then surviving in the hcq group.
where do you see this breakdown? I only see the composite endpoint of "Respiratory Failure" by treatment group, and the overall statement "Among the 1376 patients included in the analysis, the primary end point of respiratory failure developed in 346 patients (25.1%); a total of 180 patients were intubated, and 166 died without intubation. "
Posted on 5/13/20 at 9:52 am to shell01
the numbers are buried in the supplemental appendices of the study. check my link in the OP for the breakdown
Posted on 5/13/20 at 9:53 am to Sasquatch Smash
quote:
If those percentage numbers play out the same or similarly as you increase your population yet they aren't statistically different by the test, wouldn't you still want the outcome that's 29% better?
that's not how that works....
Statistical Significance is not about how much better or worse treatment a is than treatment b, it's about how confident you are that any difference at all is not due to chance.
Posted on 5/13/20 at 9:55 am to Roger Klarvin
quote:
The addition of azithromycin I’m a little more opinionated about as an ID specialist by training.
Not trying to be adversarial, but we did not know amiodarone effects on the rapid component of the delayed rectifier channel*, yet it worked and is still used. The point I am trying to (obliquely) make: if studies can support effect, that should not stop us from using it within prior established QTc parameters and monitoring. Many meds have been used without understanding exact mechanism of action. Perhaps AZT used here is not from infections arising secondary to COVID-19.
Just to be clear, I place great value in views of ID docs and work with them on ABX stewardship issues. This is just to illustrate a point.
* I am wild arse guessing this may be where cardiac issues arise with HCQ +/- Azithromycin.
This post was edited on 5/13/20 at 9:57 am
Posted on 5/13/20 at 9:55 am to Sasquatch Smash
quote:
We scientist likely put too much faith in statistical significance.
Well there’s a red hot sports take
quote:
If those percentage numbers play out the same or similarly as you increase your population yet they aren't statistically different by the test, wouldn't you still want the outcome that's 29% better?
Statistical significance means the odds that your results were due to chance are low.
Posted on 5/13/20 at 9:56 am to Tiguar
quote:
the reason I don't suggest prophylactic use for the general public is long-term use is associated with other issues
LINK /
quote:
Yes, if you get too much. Signs of too much zinc include nausea, vomiting, loss of appetite, stomach cramps, diarrhea, and headaches. When people take too much zinc for a long time, they sometimes have problems such as low copper levels, lower immunity, and low levels of HDL cholesterol (the “good” cholesterol).
it skews the risk/benefit ratio for something that "might help, probably won't hurt"
You’re not wrong about becoming nauseous after taking too much zinc. I can have a similar issue with some forms of vitamin C, namely the hard tablets......liquid doesn’t seem to bother me.
Daily I’m taking a zinc/calcium/magnesium multi cap, turmeric/curcumin. D-3, Omega 3, CoQ10, oil of oregano and a table spoon of colloidal silver. Probably should add vitamin C too but all I have in the house is the hard caps and they tend to make me nauseous.
Posted on 5/13/20 at 9:56 am to Roger Klarvin
quote:And no one claimed that.
But you have no choice with regards to who was treated
quote:Or you have suitable study entry criteria.
If the distribution of treatment is heavily skewed towards those with or without a given condition, that’s just the way it is. You just have to make eye and acknowledge the limitations, which they did.
Posted on 5/13/20 at 9:56 am to shell01
quote:
that's not how that works....
Statistical Significance is not about how much better or worse treatment a is than treatment b, it's about how confident you are that any difference at all is not due to chance.
I know, but again...just because a result isn't statistically different doesn't mean we should ignore observed differences nor should we assume something is actually there because it was statistically significant.
Give this editorial from the American Statistician a read, if you have the chance, to see what statisticians have been trying to tell us for a while now.
This post was edited on 5/13/20 at 10:18 am
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