I just got off a 16 hour shift in the ICU despite it being 12 hours, and was surprised to see this thread ballooned to over 60 posts since I last saw it. The majority of my personal census today were COVID patients on ventilators with very high requirements. I'd estimate that maybe half of my patients had been on hydroxychloroquine prior to presenting to me and in early on I their course, the other half not. All of them were in critical condition with persistent hypoxic respiratory failure despite aggressive interventions. Am I going around saying HCL doesn't work? No, because I'm not an a**hole. All myself and other providers have said in this thread is simply that there is no evidence that hydroxychloroquine is effective. Could I be wrong? Absolutely. But in my experience, the evidence simply isn't there and at present there is no concrete evidence that it is effective. I am not telling others not to use it, go ahead, I'm just saying stop going around saying this is a miracle cure and it has a definitive effect when there is NO evidence to support that claim at present.

The thought that clinical providers, like myself, don't have time to review the latest research is absurd. I seek out the latest evidence and guidelines to help guide my care because I actually don't want these people to die. I don't give a flying f*** if Trump or Fauci endorses something or not, because honestly their opinions don't matter to how I practice (although one of those opinions I put much less stock in given their lack of medical training). I get daily updates from the New England Journal of Medicine, American College of Physicians, CHEST, the Society of Critical Care Medicine, Elsevier, and UpToDate on studies revolving around COVID and the multitude of therapeutics that are being evaluated. Each of those entities do their best to relay the latest updates on COVID management and clinical trials. The insinuation that myself and other clinical providers are misinformed is just ignorant, and on par with the F16 poster who blatantly stated that providers who don't use hydroxychloroquine want patients to die.

This will be my last post on this thread, people have made up their minds and drawn their lines in the sand. This topic no longer is a debate over clinical efficacy based on tangible evidence, but one injected with emotion and politics. God speed to the other docs on this thread who continue to fight this futile battle.

ETA: it honestly seems like the pro-HCL crowd are throwing s*** on the wall and hoping it sticks in order to discredit anyone who disagrees with them. In the words of Jacobim Mugatu, "I feel like I'm taking crazy pills".

Sorry, will post again to answer your question. By the time patients get to me, there is likely no utility in using HCL. HCL's proposed mechanism is inhibiting viral replication, which is early on. If you follow the viral load, viral load is high early on in the course of infection, which is why people are recommending its use early on when viral replication is high. The majority of patients who decompensate and require medical evaluation and critical care are because of the immune response to the virus and not due to the actual virus which instigated that immune response, a lot of these patients who are critical do not have high viral loads. They do their damage and induce an inflammatory response which causes the ongoing issues. By the time I see them, the name of the game is supportive treatment, and reducing inflammation, and not actual treating the actual virus. Which is why steroids have become a mainstay of treatment. Although at present I still don't think there are significant studies that support that claim, but in theory the reasoning is sound.

This graph illustrates my point:


If you can inhibit viral replication early, then hopefully you can prevent the cytokine release and inflammatory response induced by the virus. But once that process kicks off, IMO HCL has no impact.

Mantis Toboggan MD said:

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Sorry, will post again to answer your question. By the time patients get to me, there is likely no utility in using HCL. HCL's proposed mechanism is inhibiting viral replication, which is early on. If you follow the viral load, viral load is high early on in the course of infection, which is why people are recommending its use early on when viral replication is high. The majority of patients who decompensate and require medical evaluation and critical care are because of the immune response to the virus and not due to the actual virus which instigated that immune response, a lot of these patients who are critical do not have high viral loads. They do their damage and induce an inflammatory response which causes the ongoing issues. By the time I see them, the name of the game is supportive treatment, and reducing inflammation, and not actual treating the actual virus. Which is why steroids have become a mainstay of treatment. Although at present I still don't think there are significant studies that support that claim, but in theory the reasoning is sound.

This graph illustrates my point:


If you can inhibit viral replication early, then hopefully you can prevent the cytokine release and inflammatory response induced by the virus. But once that process kicks off, IMO HCL has no impact.

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Great stuff. Don't make this your last post on the subject. We need to keep fighting the good fight.

Let's look for more treatments, not stick to old treatments that don't work.

Derrida said:

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My search potential is obviously lacking. I was given a list from a person with a political agenda who claims HCQ to be effective, showing 65 studies.

The ones he relies on are retrospective studies.

Is there a site repudiating these claims?

https://c19study.com/

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Don't need a site to address their claims, they have changed the results to every single negative prophylaxis or early RCT to either "positive" or "inconclusive" which clearly demonstrates they don't care about the truth. You don't get to ignore the results of an RCT just because you don't like the outcome. It is incredibly disingenuous to change results of a study to further your own politically motivated opinions on a drug. They also make the mistake of putting randomized control trials on the same level as observational studies which no one with any sort of understanding of medical literature appraisal would ever do. Those of us that appraise medical literature and help create guidelines for clinical practice don't group all the available studies on a specific drug, and just look at the percentage of positive studies. That is just silly.

EyeBalz said:

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Interesting piece from Sharyl Attkisson:

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And Vaccines cause autism..

Derrick: "taken to task...". Really? By an anonymous blogger that calls himself "the Orac" . I'll stick w the Yale epidemiologist thank you.

I only posted the piece about HCQ. You're the one posting the piece about Autism and vaccines.

Why do people always want to undercut a news piece based on its source. I have liberal friends who immediately dismiss anything that comes from Breitbart regardless of the content of the story? It's a typical liberal ploy.

The HCQ story stands on its own, regardless of what other topics Sharyl Attkisson has covered. The idea that 100% of Breitbart or Attkisson's stories lack credibility it preposterous.

sbrk said:

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Question for the docs/researchers here: considering that the evidence for/against HCQ is, shall we say, inconclusive, at what point is it ethically questionable to continue to run trials for it?

If HCQ was the only possible treatment on the table, I could understand continuing to research it, but it seems that the front-line treatments have progressed, both on the anti-viral (favipiravir, remdesivir?) and immune (toci, dexamethasone) front.

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HCQ (with zinc and Azithromycin) is proposed to uniquely mitigate the severity of the Covid infection by limiting viral proliferation. Until a proper study is undertaken to evaluate it's (H/Z/A) efficacy when used early in the course in the infection, we will not have an answer. The drug cocktail is safe and there is no other treatment available at the early stage of the infection oe might choose to use instead.

I say test it. It would be unethical not to.

Because a story that's an appeal to authority rests solely on the authority. There's no independent research there for us to evaluate. Just some persons opinion. If that person is a kook, it's definitely relevant.

EyeBalz said:

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I only posted the piece about HCQ. You're the one posting the piece about Autism and vaccines.

Why do people always want to undercut a news piece based on its source. I have liberal friends who immediately dismiss anything that comes from Breitbart regardless of the content of the story? It's a typical liberal ploy.

The HCQ story stands on its own, regardless of what other topics Sharyl Attkisson has covered. The idea that 100% of Breitbart or Attkisson's stories lack credibility it preposterous.

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People who cover "vaccines cause autism" are not reporters, they are opportunist that know there is a market for selling horse**** to idiots.

Well, 95% of media is liberal, so what do you expect, of course the majority of fake news is liberal slant.

sbrk said:

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EyeBalz said:

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sbrk said:

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Question for the docs/researchers here: considering that the evidence for/against HCQ is, shall we say, inconclusive, at what point is it ethically questionable to continue to run trials for it?

If HCQ was the only possible treatment on the table, I could understand continuing to research it, but it seems that the front-line treatments have progressed, both on the anti-viral (favipiravir, remdesivir?) and immune (toci, dexamethasone) front.

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HCQ (with zinc and Azithromycin) is proposed to uniquely mitigate the severity of the Covid infection by limiting viral proliferation. Until a proper study is undertaken to evaluate it's (H/Z/A) efficacy when used early in the course in the infection, we will not have an answer. The drug cocktail is safe and there is no other treatment available at the early stage of the infection oe might choose to use instead.

I say test it. It would be unethical not to.

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Should HCL trials be prioritised over other trials for other promising treatments?

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There are plenty of infected people out there to study everything needing attention without prioritizing any one drug, in my opinion.

Quote:

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So are you calling Dr William O'Neal, Medical Director at Henry Ford Medical Center a kook?

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The Ford study initially got me curious as well, but then qualified groups quickly pointed out flaws.

https://www.beckershospitalreview.com/pharmacy/recent-hydroxychloroquine-study-draws-criticism-from-medical-community.html

https://www.cnn.com/2020/07/31/health/hydroxychloroquine-study-henry-ford-letters/index.html

No, but a lot of the HCQ proponents are. At any rate, there's a reason that appeal to authority is a logical fallacy. It doesn't matter how venerable the authority is, at the end of the day its the evidence that matters - not who is presenting it.

EyeBalz said:

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I only posted the piece about HCQ. You're the one posting the piece about Autism and vaccines.

Why do people always want to undercut a news piece based on its source. I have liberal friends who immediately dismiss anything that comes from Breitbart regardless of the content of the story? It's a typical liberal ploy.

The HCQ story stands on its own, regardless of what other topics Sharyl Attkisson has covered. The idea that 100% of Breitbart or Attkisson's stories lack credibility it preposterous.

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You made an appeal to authority, and thus calling that authority into question based on the entirety of their claims is absolutely warranted.

It's not ad hominem if it directly casts doubt on the authority of the figure you're citing.

Picadillo said:

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"Finding flaws" in the Henry Ford Study are bogus...

In addition, a high percentage of drugs approved by FDA have never been thru the randomized double blind study approach. That is reserved for HCQ.

Most of these critics are Big Pharma funded

https://www.google.com/amp/s/amp.detroitnews.com/amp/5571987002

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Big Pharma?

Let's not use the lingof of Anti-Vaxxers.

It takes a billions and/or millions to get an NDA or BLA approved by the FDA. No small company can go through the clinical trials to get a drug or vaccine approved.

There is no massive conspiracy by pharmaceutical companies. Stop it.

Picadillo said:

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"Finding flaws" in the Henry Ford Study are bogus...

In addition, a high percentage of drugs approved by FDA have never been thru the randomized double blind study approach. That is reserved for HCQ.

Most of these critics are Big Pharma funded

https://www.google.com/amp/s/amp.detroitnews.com/amp/5571987002

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LOLWUT?! This is just straight up trolling at this point.

Red Fishing Ag93 said:

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Derrida said:

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Picadillo said:

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"Finding flaws" in the Henry Ford Study are bogus...

In addition, a high percentage of drugs approved by FDA have never been thru the randomized double blind study approach. That is reserved for HCQ.

Most of these critics are Big Pharma funded

https://www.google.com/amp/s/amp.detroitnews.com/amp/5571987002

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Big Pharma?

Let's not use the lingof of Anti-Vaxxers.

It takes a billions and/or millions to get an NDA or BLA approved by the FDA. No small company can go through the clinical trials to get a drug or vaccine approved.

There is no massive conspiracy by pharmaceutical companies. Stop it.

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BS.

It is very massive.

Every presidential election year there is one subject that both parties agree with. That only one is bringing down the cost of drugs here in the U.S.

Then afterwards, nothing happens. After another four years, both sides again say they agree to do something about it.

And nothing.

There is a masive amount of money spread around to stop congress from acting.

(But wouldn't ya know it, an outsider finally is working to make it happen with an EO!) Haha.

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We are not tinfoil hat wearers here. Come on, let's stop with the Big Pharma rhetoric.

The media cost to bring a new drug to market is 985 Million Dollars.

https://www.biospace.com/article/median-cost-of-bringing-a-new-drug-to-market-985-million/

That is before ONE PENNY is earned.

Picadillo said:

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"Finding flaws" in the Henry Ford Study are bogus...

In addition, a high percentage of drugs approved by FDA have never been thru the randomized double blind study approach. That is reserved for HCQ.

Most of these critics are Big Pharma funded

https://www.google.com/amp/s/amp.detroitnews.com/amp/5571987002

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This is the stupidest thing in this entire thread. Please name for me just one drug approved by the FDA that did not go through stringent RCT. If you believe this you need to try to be more rationale. If this was some sort of big conspiracy by big Pharma to get more expensive drugs to treat COVID then why is dexamethasone a very cheap steroid being used and has proven to reduce deaths in COVID19? The problem with HCQ cocktail is that reaching statistical significance in a RCT for early treatment will be very difficult if not impossible to reach. I am thinking I would take it myself if within the first couple of days of symptoms based on the MOA of the cocktail, it could help but unlikely to be proven to do so.