Worst of all, there is no evidence from this paper that these two drugs made any difference in the clinical outcomes of these patients. I understand that this was a pilot study and that it will require a much larger trial to determine if hydroxychloroquine has any effect on clinical outcomes, but the hype over this study is unconscionable. This is at best an uncertain result from a very preliminary study with very serious methodological shortcomings that looked only at viral positivity in nasopharyngeal aspirates. The authors justify their publication thusly:
For ethical reasons and because our first results are so significant and evident we decide to share our findings with the medical community, given the urgent need for an effective drug against SARS-CoV-2 in the current pandemic context.
We show here that hydroxychloroquine is efficient in clearing viral nasopharyngeal carriage of SARS-CoV-2 in COVID-19 patients in only three to six days, in most patients. A significant difference was observed between hydroxychloroquine-treated patients and controls starting even on day3 post-inclusion.
No, the ethical thing to do would have been to analyze the data properly and go through peer review.
Hi Josh
Thanks for posting this. Are the P values posted on the various data points accurate given the issues with the methods that were discussed?
I have heard there are trials going on in NY but nothing has been published yet.
No, the ethical thing to do for a doctor who, from the best of his knowledge and experience, has the conviction that a treatment can save his patient’s life is to give him the treatment, specially if he has more than enough data demonstrating its inocuity. And it is exactly what the Professor Raoult is doing with Hydroxychloroquine.
Turns out that Hydroxychloroquine has a low therapeutic index, meaning it is hard to avoid an overdose. Who knows what the relative trade off between the benefit and risk? Who could possibly have a solid and grounded conviction about this?
The President of the United States, of course.
Edited: And clearly a number of other stable geniuses who participate in this group…
Hydroxychloroquine has been available since 1955.
Thanks for the typo correction @colewd. WE have know about it since 1955, which how we know that it is not a benign medication. I hope it works, but it comes with real risks.
There’s something oddly Darwinian about all the stable geniouses gurgling chemicals of questionable efficacy on the say-so of the Trumpenführer.
It turns out that professor Raoult is maybe the best expert in the world in the field of infectious diseases. These last 30 years, he has treated more than 3000 of his patients with Hydroxychloroquine. There is probably no other doctor in the world that has such a deep knowledge of this drug. So the answer to your questions « Who knows what the relative trade off between the benefit and risk? Who could possibly have a solid and grounded conviction about this? » is: Professor Raoult.
There is no such thing. There are experts in much more narrow areas, and it’s probably not even possible to say who is the “best in the world” in any of them.
There is a site called expertscape that allows one to find who are the world best experts in a given field.
http://expertscape.com/
You may try the field « communicable diseases » and see who will figure at the output.
That’s hilarious.
Great paper. Thanks. It’s a much needed critique.I did not know that chloroquine was found to be active in vitro but not in vivo, and the study didn’t take into consideration those who wound up going to ICU and dying! It’s a very small N value, too.
.Thanks.
Under appropriate circumstances you do check serial ekgs (baseline and then after dose change and yearly) to confirm no QTc interval prolongation and yearly retinal screens. Chloroquine is used by rheumatologist and even primary care docs for inflammatory arthritis. It is in tonic water and used for malaria prophylaxis on some areas, but you don’t want to give it indiscriminately. It is no longer available for leg cramps because of risks, for example.
A scathing review of the study and of Dr. Raoult’s research in general and his character:
Really worth a read.
How in the world does a scientist like that advance to his position?
My hypothesis is that everyone has at least one bat-crazy, non-rational idea they just can’t shake. And no amount of empirical evidence will counter that. One can only hope that one’s own nutty idea doesn’t impact their outside relationships and professional work. Some people are not so lucky.
- Peter Duesburg believes to this day the HIV is not the causal factor in AIDS.
- Luc Montagnier, the discoverer of HIV thinks DNA emits specific radio waves as part of his justification of homeopathy.
- Brian Josephson is enamored of parapsychology
There are any number of less well known and less talented people who display similar issues. And some people are just nuts front to back…
Another stable genius. To be honest, something this big is going to bring a lot of behavioral pathologies to the surface. It’s to be expected.
He does not seem stable at all.
Thanks for the post. I found this sub article informative.