> On 7 Aug 2020, at 13:09, PGC <[email protected]> wrote: > > > > On Friday, August 7, 2020 at 12:38:28 PM UTC+2, Bruno Marchal wrote: > >> On 7 Aug 2020, at 00:52, 'Brent Meeker' via Everything List >> <[email protected] <javascript:>> wrote: >> >> 8 | DISCUSSION As hospitals around the globe have filled with patients with >> COVID-19, front line providers remain without effective therapeutic tools to >> directly combat the disease. The initial anecdotal reports out of China led >> to the initial wide uptake of HCQ and to a lesser extent CQ for many >> hospitalized patients with COVID-19 around the globe. As more data have >> become available, enthusiasm for these medications has been tempered. Well >> designed, large randomized controlled trials are needed to help determine >> what role, if any, these medications should have in treating COVID-19 moving >> forwards. While HCQ has in vitro activity against a number of viruses, it >> does not act like more typical nucleoside/tide antiviral drugs. For >> instance, HCQ is not thought to act on the critical viral enzymes including >> the RNA-dependent RNA polymerase, helicase, or proteases. Despite in vitro >> activity against influenza, in a large high quality randomized controlled >> trial, it showed no clinical benefit, suggesting that similar discordance >> between in vitro and in vivo observations is possible for SARS-CoV and >> SARS-CoV-273 (Table 3). >> >> >> Additionally, HCQ and especially CQ have cardiovascular and other risks, >> particularly when these agents are used at high doses or combined with >> certain other agents. While large scale studies have demonstrated that >> long-term treatment with CQ or HCQ does not increase the incidence of >> infection, caution should be exercised in extrapolating safety from the >> studies of chronic administration to largely healthy individuals to estimate >> the risk associated with short-course treatment in acutely and severely ill >> patients. Furthermore, the immunologic actions that make HCQ an important >> drug for the treatment of auto-immune diseases might have unintended >> consequences when it is used for patients with COVID-19. The effects of this >> immune modulation on patients with COVID-19 are unknown at this time, >> including a potential negative impact on antiviral innate and adaptive >> immune responses which need to be considered and studied. For all these >> reasons, and in the context of accumulating preclinical and clinical data, >> we recommend that HCQ only be used for COVID-19 in the context of a >> carefully constructed randomized clinical trial. If this agent is used >> outside of a clinical trial, the risks and benefits should be rigorously >> weighed on a case-by-case basis and reviewed in light of both the immune >> dysfunction induced by the virus and known antiviral and immune modulatory >> actions of HCQ. >> >> https://faseb.onlinelibrary.wiley.com/doi/pdfdirect/10.1096/fj.202000919 >> <https://faseb.onlinelibrary.wiley.com/doi/pdfdirect/10.1096/fj.202000919> > > > Just to be sure, I have no problem with this. My point is just that today, > there are studies indicating that HCQ might be slightly better than > Remdesevir, and that the Media are wrong when mocking Trump on HCQ in some > systematic way. > > You're out of your field here. People out on the front lines shouldn't be > subjecting high numbers of suffering folks to medical treatment based on some > studies indicating "might be slightly better than…".
If serious studies shows that a medication is better than another, why not, in case you do have confidence in those studies of course. As you say, I am not a physician, and I have no real clue which medication I would use. My point was just that it is hard to trust the FDA on this, and the media is not exceptionally valid on this. > As Brent quoted, it should read "Well designed, large randomized controlled > trials are needed". You make it a point to advertise your humility and > awareness of your ignorance as a scientist. Thankfully, Doctors around the > world are not mechanists according to Bruno or Raoults and act with more > humility and cooler heads relative to the studies you refer to, and interpret > them as premature, until more solid evidence may change the picture. ? > > Most people in the virology community defending HCQ are not favorable to the > preventive use of HCQ, and propose precise protocol to be used, and actually, > claims that it asks for a higher doze than its usual use, justifying a > medical prescription. Only doctors could use it. And yes, that can have > advert effect, but according to Raoult, they are slightly less severe than > the one accompanying Remdesevir. > > He doesn't provide that evidence. Not at the standards we're talking about. He does, or at least he provided many references. I do not conclude anything about the content of those papers; My point is that such analysis exist (Jason gave some links to them). According to Raoult, Hydroxychloroquine is slightly better than Remdesevir, and less dangerous. I do have some feeling that might be true, because the countries using it do better that those without it, but this should be analysed more seriously, by taking other factors into account. > > > Some Media makes me nervous because they argument seems to be just “Trump > said x” so x is stupid”, which is of course a stupid argument, even if > without any other information it makes some abductive sense (I do not > disagree with Clark on this). > > That distracts from the work and evaluations that the majority working on the > field are taking every day. The entire field globally is faced with an > unprecedented workload so it is hardly a surprise that people don't have the > time to go on social media to pontificate about arguments. That's a problem > because disinformation inflates itself with the self-righteousness of folks > articulating their voices in a digitalized world. And while I'm all for > liberty of expression, disinformation is a problem and unconscious folks > articulating what are essentially responses of psychological shock, > amplifying each others' disinformation, erodes the credibility (while > drowning out in terms of pure noise) the already complex > discourses/practices, that adapt and change as data keeps emerging, of the > entire concerned medical fields. PGC Sure, disinformation is a problem, and doubly so in the health domain, since prohibition, and more deeply, since the separation of the human science from the exact science (itself coming from the separation of theology from science). We still allow people to believe what they want to believe, and there is an obvious growing complacency with lies, as the very existence of Trump illustrates. Bruno > > -- > You received this message because you are subscribed to the Google Groups > "Everything List" group. > To unsubscribe from this group and stop receiving emails from it, send an > email to [email protected] > <mailto:[email protected]>. > To view this discussion on the web visit > https://groups.google.com/d/msgid/everything-list/7b9003fd-8db6-4272-b0fb-cd4ee2db5021o%40googlegroups.com > > <https://groups.google.com/d/msgid/everything-list/7b9003fd-8db6-4272-b0fb-cd4ee2db5021o%40googlegroups.com?utm_medium=email&utm_source=footer>. -- You received this message because you are subscribed to the Google Groups "Everything List" group. To unsubscribe from this group and stop receiving emails from it, send an email to [email protected]. To view this discussion on the web visit https://groups.google.com/d/msgid/everything-list/8216054D-EBFF-42BD-A5B3-7A0F882B0D09%40ulb.ac.be.
