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Drug boosterism

July 29, 2020

Like everyone, I hope we find more drugs that are effective against Covid-19. Doctors and hospitals aren’t spurning hydroxychloroquine because they are raging leftists or hate Trump, but because it keeps failing in RCTs. They learn this by reading peer-reviewed research in medical journals. Josh Batts writes a good Facebook post explaining that history, with links to some of the relevant research.

Twenty years back, one had to go to a medical library to read those articles. When I lived in Austin, I often was quite grateful that the Texas Medical Association library there was so convenient. Now, all that research is online (though sometimes behind a paywall.) I hear many people complain they don’t like how the popular press reports on the research for drugs. Well, the research itself is just a click away.

Unless one is investing in some of the companies concerned, I have a difficult time understanding why someone would become a booster or opponent of any particular drug. Drug development isn’t football. There isn’t any exciting action to televise at a sports bar. There won’t be any tailgate parties. It makes a lousy spectator sport. I suspect one of the things historians will puzzle about this odd time in our nation is how so many Americans became such strong boosters of specific drugs, as if they were sports teams.

Update: Assistant Secretary for Health Brett Giroir makes the same point. Now, yes, maybe all the RCTs to date have the wrong protocol, and some other protocol works. What those proposing such need to do is organize an RCT showing that.

2 Comments leave one →
  1. Michael Grossberg permalink
    July 30, 2020 2:26 pm

    Russell, why have so many hospitals, universities and leading doctors and professors across the country – as well as around the world – kept publishing articles in journals reporting the efficacy of the early treatment at moderate doses of hydroxychloroquine (often with that anti-viral plus zinc) when given to their hundreds and thousands of patients, with notably lower death rates?
    Some of these doctors are risking a lot by speaking out, given their high prestige positions at respected hospitals and universities – especially with the President, other politicians and the media having so highly politicized this drug when it should be entirely a matter of medicine.
    Re: “July 2, 2020

    DETROIT – Treatment with hydroxychloroquine cut the death rate significantly in sick patients hospitalized with COVID-19 – and without heart-related side-effects, according to a new study published by Henry Ford Health System.
    In a large-scale retrospective analysis of 2,541 patients hospitalized between March 10 and May 2, 2020 across the system’s six hospitals, the study found 13% of those treated with hydroxychloroquine alone died compared to 26.4% not treated with hydroxychloroquine. None of the patients had documented serious heart abnormalities; however, patients were monitored for a heart condition routinely pointed to as a reason to avoid the drug as a treatment for COVID-19.
    The study was published today in the International Journal of Infectious Diseases, the peer-reviewed, open-access online publication of the International Society of Infectious Diseases (ISID.org).
    “The findings have been highly analyzed and peer-reviewed,” said Dr. Marcus Zervos, division head of Infectious Disease for Henry Ford Health System, who co-authored the study with Henry Ford epidemiologist Samia Arshad. “We attribute our findings that differ from other studies to early treatment, and part of a combination of interventions that were done in supportive care of patients, including careful cardiac monitoring. Our dosing also differed from other studies not showing a benefit of the drug. And other studies are either not peer reviewed, have limited numbers of patients, different patient populations or other differences from our patients.”
    Zervos said the potential for a surge in the fall or sooner, and infections continuing worldwide, show an urgency to identifying inexpensive and effective therapies and preventions.
    “We’re glad to add to the scientific knowledge base on the role and how best to use therapies as we work around the world to provide insight,” he said. “Considered in the context of current studies on the use of hydroxychloroquine for COVID-19, our results suggest that the drug may have an important role to play in reducing COVID-19 mortality.”
    The study also found those treated with azithromycin alone or a combination of hydroxychloroquine and azithromycin also fared slightly better than those not treated with the drugs, according to the Henry Ford data. The analysis found 22.4% of those treated only with azithromycin died, and 20.1% treated with a combination of azithromycin and hydroxychloroquine died, compared to 26.4% of patients dying who were not treated with either medication.
    “Our analysis shows that using hydroxychloroquine helped saves lives,” said neurosurgeon Dr. Steven Kalkanis, CEO, Henry Ford Medical Group and Senior Vice President and Chief Academic Officer of Henry Ford Health System. “As doctors and scientists, we look to the data for insight. And the data here is clear that there was benefit to using the drug as a treatment for sick, hospitalized patients.”
    https://www.henryford.com/news/2020/07/hydro-treatment-study?fbclid=IwAR0cNsnduMgAl_v9ZYwFby3g77OrkpEjspC_5c91IGzLJkKU8L9qjAZeRiI

  2. rturpin permalink*
    August 2, 2020 1:41 pm

    Michael, trials without randomization are infamously subject to selection bias. There is a technical term for a drug that does great in all its trials, except that it fails to work in RCTs: ineffective.

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