Funny Trial Result: Burying the Lead

So Covid19Crusher, one of my pandemic heroes, posted an RCT on outpatient Colchine therapy today.  (Colchine – unlike ivermectin – appears to have a fairly narrow theraputic index, meaning it is easy to overdose.  Side effects also.  Important to be careful with this one).  While the trial data looked encouraging (deaths cut in half, ventilations also, with hospitalizations cut by 23%), when poking through the data, I ran across a very odd result.

A very, very odd result.  It had nothing to do with colchine at all.

So – the trial itself:

https://www.medrxiv.org/content/10.1101/2021.01.26.21250494v1.full-text

The “primary endpoint” (either hospitalization, or death) results were as follows:

colchine 104/2235 (4.7%) vs placebo 131/2253 (5.8%) with p=0.08.

Positive for colchine, but not significant.  When they split the endpoints more granularly, significance does appear – positive for colchine.

But once you look at the subgroups, it seems that different groups do better than others.  Females, as we know, really outperform males for COVID.  [Maybe take the estrogen, guys, and get that “transition” you always secretly wanted?  Beats colchine for sure.]

But one group did even better than females.

Current smokers!!!  And not by a little, either.  And not colchine-smokers.  Placebo-smokers!  They were literally the best of the bunch.  Were they the youngest?  Was there some other confounder in there?  I don’t know.

Also, there have been other trials that show that nasal sprays do very well.  And various nebulized compounds, too.

So – perhaps smoking acts the same way.  Maybe smoking drops niacin/niacinamide/other-particulates right on top of the virus and – maybe – really interferes with replication.  [Note: this was an outpatient study, so the “active smokers” could indeed be smoking – and probably were – all during the treatment period.]

Or perhaps this is just happenstance and/or it was a very young group who were smokers?

Or, just perhaps, vaporized niacin/niacinamide in the respiratory tract really does cure COVID.

Anyhow.  Just something that caught my eye.

Another dot to connect into the Covid-19 vs smoking conundrum bucket.  This has been a clear pattern from early on and that is a super strong signal right there, as you say in the placebo group.  Indeed, the real trick here maybe the inhaled delivery of the payload (in this case, we think, nicotinic acid) right to where it’s needed to provide early attack to a respiratory virus.  This would maybe explain why just a little bit (of nicotinic acid) goes a long way when delivered to the right tissues.  As I write this I am going through my morning (1 gram) B3 flush : )

For those who don’t know, the ever creative Dr. Zelenko has been experimenting with better ways to deliver HCQ through nebulization also – the result is much, much faster response by patients;

https://docs.google.com/document/d/1WjfphkNfYDxF4MMw7bS9HJpmeGuhwEFuJkUTexjHHOc/edit

Interesting study by Dr Z. I’d love to see a head-to-head trial of nebulized HCQ vs nebulized hydrogen peroxide including efficacy + by-products.

So smoking has one advantage over “nebulized HCQ”.

It is literally available everywhere.  Today.

And it is cheap.

I mean, I don’t like smoke.  Then again…maybe you only need to smoke for the duration of your COVID19 infection?

“Always have a go-to-hell plan.”  — Col David Hackworth.

I’m…only half kidding here.  To do nebulized H2O2, you need – a nebulizer.  And the H2O2.  To do smoking, you pretty much just need a match and a nearby 7-11.

Can you imagine if this was really a thing, and it went worldwide?

Reminds me of the Woody Allen movie. Forget the name. He travels forward in time and cigarettes are a healthy inhalable tonic and lots of fat,  meat eating is encouraged. Oh, think the movie was, ‘Sleepers.’

https://www.youtube.com/watch?v=D2fYguIX17Q

Just watched it. Oh man, this is funnier today than when I watched it 30 years ago. And kind of prescient in a several different ways!