> On 7 Aug 2020, at 20:41, PGC <[email protected]> wrote: > > > > On Friday, August 7, 2020 at 4:53:50 PM UTC+2, Bruno Marchal wrote: > >> On 7 Aug 2020, at 13:09, PGC <[email protected] <javascript:>> 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] <>> 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. > > Many? You're joking right? You can have a ton of references to PrEP, PEP, or > alternatively conceived and designed type studies and it's everybody's right > to believe in them and to take that medication if they wish. If folks want to > confuse quantity with quality, that's their choice. > > It's you guys that are following references/names without a guiding > principle/standard as you'll accept anything that goes in your discursive > direction, with Christian "if they lied to us, then they are liars" type > judgements embedded in the assumptions of your statements. What does that > ever indicate? > > I'll side with the more cautious and qualitative notion of effective in terms > of well designed, large randomized controlled clinical trials. It's you guys > that are following references/names without a guiding principle/standard as > you'll accept anything that goes in your discursive direction. PGC
That makes sense for academic research, but the real-life doctors cannot way for an academical response in urgent situation, and that is the context of the HCQ/remdesevir domain, where many argument against the work of Didier Raoult was nothing by a sort of harassment, not by its peers, but by media, a bit with the argument “Trump said it so it has to be false”. That argument certainly makes some sense, but is not conclusive, especially when the opponents (the FDA) has a tradition of lies in the domain. 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/d93dc582-97f2-4903-9d5e-184f4519c903o%40googlegroups.com > > <https://groups.google.com/d/msgid/everything-list/d93dc582-97f2-4903-9d5e-184f4519c903o%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/9BA1F99D-97DC-4301-B56D-2856349ABC2D%40ulb.ac.be.
