An HCQ post making the rounds
I’ve encountered a post about HCQ that has been making the rounds on Facebook. It’s in response to the doctors in the video from the steps of the Capitol. Setting aside whether some of them are quacks or not, and there being a cure of not for coronavirus, I’m posting this just in the context of the problem of the political stepchilding of an otherwise useful and heretofore drug of Chloriquine and it’s derivatives.
There are some referenced/linked in the post that I don’t have time to digest just now. But I suspect they are same old par for the course: HCQ given past it’s window of optimal utility, and give without zinc, which should be the primary object in the discussion, HCQ being what helps it work. Also, a flat out ommission of studies, well done as well, that I’ve seen that show HCQ with zinc is Much more useful than the wonder drug (wonder how I can afford it) remdisavir.
About a dozen people have sent me a video featuring “America’s Frontline Doctors” and an associated post, asking for my…
Screw it. We’re going Live!
About a dozen people have sent me a video featuring “America’s Frontline Doctors” and an associated post, asking for my thoughts. For anyone who may be interested in my perspective, I share it below. It is long.
I have also included/rephrased some thoughts from Marcee Wilder, MD, MPH, an Emergency Medicine physician at my medical school alma mater (George Washington University). We are both board-certified in our specialties and have hospital privileges (important credibility information about any physician) and are open to sharing this post.
As you know, coronavirus (aka SARS-CoV-2) is a novel (new) virus with much still unknown. The medical community has been scrambling for answers on how best to care for COVID patients. While the virus is new, what is NOT new is the scientific method (how we evaluate treatment and medications for efficacy). Methodologically sound and internally valid research (studies that can be repeated, have the same results, and are free from bias) has demonstrated that Hydroxychloroquine (HCQ) does not have a mortality benefit (i.e. does not keep you from dying) and carries a risk of serious adverse events (liver decompensation, organ failure). Several high-quality published studies have evaluated HCQ for prevention, for treatment, and in combination with azithromycin. These studies all produced disappointing results and actually demonstrate a serious risk of harmful side effects.
Here are some important examples of trials that took place to study if HCQ was effective:
Scientists have since studied more promising treatments, like Remdesivir, which have been shown to decrease mortality.
There are hundreds of ongoing treatment trials across the US. Currently, there is a pretty strong consensus in the international medical community that HCQ does not work as a treatment for COVID. Because of this, other countries including France and Canada will not prescribe HCQ for COVID.
The recent viral video referred to above uses exaggerated and misrepresented information to paint yet another conspiracy picture, one that capitalizes on the fear that a cure is being hidden. I assure you that the other 99.9999% of America’s frontline doctors want a cure that works as badly as you do. While we can agree that corruption is widespread across many sectors of American society, it is unlikely that corruption in the business of medicine will hide a cure from us. Big pharma is sneaky, to be sure. Our government stockpiled millions of doses of HCQ and needs to do something with them, so what possible role does that play? There are obviously many questions that need to be addressed.
What does the video get right? We don’t know if the precise combo they discuss (HCQ, zinc, and Azithromycin) is helpful or safe for typical outpatients (people not hospitalized), but anecdotal evidence without a control/comparison group is pretty meaningless for patients who are likely to get better anyway, like the pediatric population. This combination of drugs needs to be studied with a randomized, placebo-controlled trial before claims can be made. Notably, the use of zinc is being evaluated in multiple ongoing studies.
I trust the scientific process. It’s just slower and harder than many like – for the sake of patients. The research infrastructure is in place for your protection. The problem is that any rag-tag group of doctors can set up a video and say whatever they want. They can speak passionately and fervently, and they might convince you they are knowledgeable (in your likely state of being tired, vulnerable, confused, and frustrated – as we all are). Should any well-intentioned physician’s clinical experiences be silenced? Absolutely not. Might they be onto something useful? Maybe, but skepticism is merited based on current research, and creating a random “press” video is not the way science is shared. Thousands of US physicians could get up on a podium in white coats, too, and tell you that in late March and early April they treated hundreds of COVID patients with Hydroxychloroquine who all died. While true, that would be anecdotal evidence, and science is not based on anecdotal evidence.
How should physicians share their findings? Through quality research and medical literature that is peer-reviewed. That’s how quality science with minimal chance for error and full disclosure of possible bias is achieved. Does it take a lot of effort and time? Yes. But that’s how we minimize the chance of missing harmful effects and ensure that something we think works, actually works.
Now…with all of that said, I invite you to consider some concerns with the sources of the video’s information.
#1: Dr. Stella Immanuel practices in Texas. Looking up her TX medical license (which she has had for only 9 months), she has no hospital privileges in the city. She is the medical director of an urgent care clinic with one review on Google. She completed a pediatrics residency in 1998 but has no board certification. How is she seeing adult/geriatric COVID patients? Where did she see a 92 year old as a pediatrician? Where did she treat 350 hospitalized COVID patients without hospital privileges? Also, she seems to have a problematic record of vocalizing falsehoods – you can find some of them on a quick google search.
#2: The other “ER” doctor in the video is not board certified, and we cannot find where she completed residency, which is concerning.
#3: Several other physicians in the video are ophthalmologists – eye surgeons. My Ophthalmology colleagues will be the first to tell you they are not “front line” doctors caring for COVID patients.
#4: These doctors belong to the AAPS, the Association of American Physicians and Surgeons. They are NOT a medical board. They are a small non-profit with 5,000 members and have a problematic track record of attempting to validate debunked medical claims (such as, HIV does not cause AIDS, abortions are the cause of breast cancer, etc.)
#5: Reconsider your trust in any doctor in July of 2020 not social distancing or wearing masks.
The video has been pulled from Twitter and Facebook not because people are “trying to hide the truth” from you or are censoring valuable scientific information. Trust that doctors would rather not risk illness and even death themselves to take care of COVID patients. I say this to remind you that we’ve lost hundreds of physicians, nurses, and other frontline workers to COVID. (A critical care giant died of COVID just yesterday, and our community is reeling from that loss). The video was pulled because it is spreading false and dangerous information.
Moving forward, please evaluate everything you read/hear/see by asking yourself, “Do I just WANT this to be true?” Also ask, “Does this align with my predetermined, preferred beliefs? Does this sit comfortably with my politics?” If so, re-assess. Sit with it. Invite opinion from someone you respect who thinks differently (if you don’t have those people in your life, that’s a red flag). Allow dialogue. Don’t get defensive. Try to be a compassionate, thoughtful human with an ability to debate. The minute we lose our belief that we could be wrong about something, we are on dangerous ground. That is the root of our division as a country, and I hope we can collectively be bigger than our current behavior, which resembles bickering preschoolers more than compassionate, thoughtful, intellectual, and dare I say it, Christ-like adults. Let’s do better.
Quickly removed.. and gates very upset at social media outlets for letting it get out and around.
If you cross reference the dosages in these studies with Drugs.com you quickly realize these doctors were ODing their patients on HCQ. Any doctor that points to these studies to suggest HCQ doesn’t work should be ashamed of themselves.
I would have to agree we should have proper studies done but because of the politicization of medicine it is hard to get anything done. However, some of the mentioned studies above were already taken apart by Dr. Martenson. Hydroxychloroquine is on the WHO’s essential medication list and like mentioned in that video it suddenly caused serious problems? That is a little suspicious to me that all of the sudden they changed their stance on it. There are minimal side effects with the medication while on proper dosage. To me at least taking HCQ does not seem like a problem and wish I could take it as a prophylactic because I do work in a hospital setting. I already take the daily recommend does of zinc and quercetin to keep my body ready for any possible infection.
I listened to the Jack Spirko recap of the front line drs conference.
While generally on board with the early HCQ/zinc narrative, the Frontline Dr presentation made me uncomfortable and less certain about the correctness of the HCQ story. There was a wierd energy in that group.
Dr Stella was very loose with her terminology, calling HCQ a ‘cure’ felt like a stretch and damaged her credibility in my opinion.
Im not surprised to hear rumblings that there are deep right wing wing views and evangelism mixed in with their treatment anecdotes.
Overall, im sick to death of added rounds of anechdotal evidence and having to overlook people that seem to suffer from strong motivated reasoning. Where in the hell are double blinded studies?
This ship is leaving port for many people, and a choice is needing to be made by many on incomplete information.
Yep. Malpractice follows bad science, eh? Or is it Bad Science follow Malpractice? It’s probably the latter.
I detect a non-scientific bias in denalizen’s comments that throw dirt on hydroxychloroquine.
On the one hand, the data from the drug company’s remdesivir clinical trial for improved mortality ARE NOT STATISTICALLY SIGNIFICANT.
On the other hand, the self reported data from his first citation of a small cohort study of ca 200 patients per group of mostly young patients cited from July 23, showed a 25% decrease in symptoms and fewer hospital admissions of patients over 50 years old but are not statistically significant either.
The former is incorrectly cited as evidence of decreased mortality remdesivir while the latter is cited as evidence of lack of effect of hydroxychloroquine. You cant have it both ways if you follow the science, doctor. This is a bias that violates the scientific method.
I also note the emphasis on dangerous side effects of hydroxychloroquine. Where was this doctor during the long period when about a billion doses of hydroxy chloroquine were dispensed for malaria without a single mortality from side effects? Why wasnt this drug banned then? Why did you let 100s of millions take this drug prophylactically for a possible disease that most would never get anyway doctor? Why did it take so long for the WHO to remove its safety assurance?
Where are all the studies done outside the control of the American pharmaceutical companies (good studies done in Korea and India for example) that are ignored? A good scientist would look at all the data, including those that disagreed with his preconceptions, even if such came from a country outside of his own and even if such data and study were not paid for or carried out by his large pharmaceutical company that is pushing a 3 thousand dollar treatment.
I dont think that this doctor is scientifically objective. Long citation to authority and degrees and studied lack of consideration of studies done outside a privileged corporate elite is not a substitute for real science.
Yes everyone would love a randomized double blind study. That costs money. Most studies are funded by the government and or big pharma ( twins if there ever was such). Many reputable doctors have used it in clinical settings with success.
My question is if I get it ” what ya got doc? ” So far the answer is supportive care. ie nothing. We are left waiting for what the managers want us to have……a vaccine.
Okay. I am on my own.
To build on the comment by MM. Indeed clinical trials cost money, but when you consider the low cost of HCQ and Zn, the fact that recruiting will not be difficult, the fact that a prospective study on early treatment would be done on an outpatient basis, and that the regimen is only about a week long (which simplifies monitoring) the issue of having the gold standard of a double-blind prospective trial should have been put to rest long ago. It is convenient to claim we lack the gold standard data while at the same time doing nothing to generate the data.
A prospective study would not be very complicated if you limited it to the following groups:
1) Negative control – standard of care (in my PCPs practice that amounts to call back if you feel worse).
2) Zn/AZT/HCQ upon early symptoms consistent with COVID and positive COVID test, since tests now appear to be available. Outcome measures could include duration of symptoms, severity of symptoms, frequency of hospital referrals, frequency of negative tests at end of regimen.
Ideally you’d include a second comparison group, Remdesevir. But I doubt an actual head-to-head comparison would ever happen.
And of course the fact that it’s worked for a lot of us is just …pfft… coincidental doo-doo.