oldmanfan

I work in Reproductive medicine and of course that is nothing like the life and death of the viral pandemic. I can tell you what we do when we have patients where they have a poor prognosis or where we don’t have decent treatment options. We are honest about things. If we are going to use a treatment empirically we are very clear on that. If we think a treatment has a 1% chance of success say, we say that. This crisis is horrifically difficult for all involved, patients, caregivers, everyone. That is why I said above I get why the drug is being prescribed for compassionate care. If it were me I would just be very clear to patients that it’s being done without real data on it. Again it’s different but I’ve seen patients in my field told by other practitioners treatment X guaranteed things would work, when based on their situation it never had s chance. And I’ve seen the devastation when we have to tell them.

Nope. Dream on. You are the one who goes on and on about him using imprecise words and that apparently you alone have the divine guidance to discern his true meaning.

Depends on how many centers you can get. Ideally you want to do a double blinded placebo controlled study. You’d have to do careful matching of subjects and controls, matching things like age, gender, clinical symptoms (like only including patients on ventilators) etc. If you could get a number of centers together you could get it done pretty quickly given the prevalence of the disease. Maybe within a month of two. The real issue would be getting informed consent and buy in from patients to participate. Patients would probably not want to be in the control group. I don’t blame them. I get it. But by doing so it negates being able to show any real effect. We are watching and hearing his exact words.

It’s a benefit/risk thing. I know docs that prescribe and I know docs that don’t. It would be interesting to know what characteristics are for the patients in Boston. Are they prescribing early? Late? Everyone? Only young patients or old? The advantage of a good clinical trial is to eliminate variables that can confound results.

If in fact it did. Science. Docs are prescribing it based on compassionate care. I get that. And I hope it truly is a cure. But I also feel for patients who died or got significant side effects from the drug that may have fought it off without the drug.

Because some keep saying the drug saves people without any real data to support that conclusion.

I don’t know if the dosages given to malaria patients are the same as those that are being given to the current Covid patients. If they are the same you would presume side effects would be similar. But again malaria is a parasitic disease and corona is a viral disease. Different pathogens have different routes of infectivity so you cannot assume what works for one pathogen works for another.

I am a reviewer for several medical journals. I reject probably 80% of the articles I’m asked to review precisely because of flaws in study design.

At this point if the drug is effective we don't Know at what stage of the disease it is so. Taking your example, I suspect but of course don’t know that if you at the point where it is expected you would die (poor O2 data, etc.) it seems unlikely to reverse disease that is so far along. Looking at diseases where it is used it seems that the drug is used fairly early in in the disease progression or as a prophylactic treatment. So let’s say you have a patient early on in the disease, you give them the drug, they develop a significant side effect and die. Now you have lost a patient that may have been one of the majority that can fight off the infection with supportive care. Docs can give this drug based on compassionate reasons. But it doesn’t mean it’s effective. I hope the studies ultimately show it does.

Again it has been studied in that disease and dosages are understood. It has not been formally studied for this virus. Science people.

No. But I will argue that Vitamin D levels have anything to do with corona virus infectivity without some actual data. And by the way, hydroxychlroquine acts in known diseases by altering endosomal synthesis from the Golgi. in my conversations with a virologist colleague the conoavirus has its own proteins for this function thus the drug would not have much effect. It has been studied in lupus patients, yes? Effective dosages, side effects? Yes? That’s one of the problems with the current studies. We don’t know if the treatment and non-treatment arms are comparable.

I am independent politically. I see your point, I also saw the exact opposite in the previous administration with media from the right. We need better right now. From everyone.

Yes. Doctors can prescribe drugs off label.

Talk to their families.

The idea as I understand it is to alter endosomal function but it is not clear whether that affects corona virus infectivity. Also from my understanding it is not clear whether dosages used for know diseases where it has positive effects such as malaria and arthritis are similar. The cell biology of infectivity differs between parasites, bacteria and viruses. The side effects as you indicate are known, but can be significant. For example the cardiovascular ones. Some early observations now suggest clotting disorders in younger infected individuals which will need to be watched. i’d live For studies to show a true positive effect of the drug against Covid-19. But let’s get real data.

So the president says something goofy, today says he was being sarcastic in a pandemic situation that demands seriousness, but it’s the observers that should be embarrassed. I think we should expect more from a president than that.

I understand that, I teach physiology. When you say it is thought, show me data and not just conjecture would be my request.

Because the president started asking about using it within the body. The staffer he was talking to was referring to the studies on aerosols or surfaces. Surface disinfection of viruses with UV is well known. So maybe if the president would actually be precise we wouldn’t have to have the media try to figure out what he’s talking about. But of course we’re all supposed to know he was being sarcastic.

The drug causes significant cardiovascular side effects. According to the limited studies several patients died from these. Why are you confused?

I said earlier that the studies talked about yesterday needed to be done to confirm that coronavirus has similar susceptibility as other viruses, which it did. Use of UV lights as antivirals has a long history.

Nope. Nebulizers are not injection. It aerosolizes medicines that are then absorbed via inhalation. I use a nebulizer on occasion for my asthma and it is not delivered under pressure nor is it forcefully inserted.

You go tell the ones that died from the side effects. The door swings both ways. That’s why Dr. Fauci and his colleagues are so important.

Again this is nothing new. I’ve used UV lights to disinfect in my lab for over 30 years. Surfaces are different than cells within the body.

I agree. What you’re not seeing is that giving the drug may save lives, it may do nothing, and it may cost lives. Do the studies. Your defense seems to always be the other person is missing the point. Then perhaps you need to make the point clearer.

Sorry but this is how science and medicine works. You don’t know if the drug caused them to recover or if they would have recovered on their own. And in one of the trials I believe a patient or two died from cardiovascular complications. Maybe they would have recovers from the virus on their own. You are reacting emotionally. Scientists and physicians can’t do that. A physician can give this drug off label. And it may alleviate symptoms or not. But you cannot say with certainty until proper studies are conducted.