Chloroquine and Hydroxychloroquine

(Utility Muffin Research Kitchen) #21

Translation: If we don’t have anything that we know that it’s working, we’ll try something else, if only for the placebo effect. And this could be any of several dozen antiviral agents.

This is a far cry from “it’s efficient”. Not the same ballpark, not even the same country.

There is another complication that doesn’t fit twitter style. The disease changes with time. First week it’s an viral infection. In week 2 lungs get damaged and we start to see autoimmune reactions. In week 3, autoimmune reactions dominate. This means, an antiviral agent is most efficient in week 1. The problem? You don’t know who will get serious symptoms, you’d have to treat all confirmed corona cases as early as possible. It’s much too late to start treatment if a patient is in earshot of an intensive care unit. Apart from drug availability, this makes studies difficult: Ressources are limited, all patients in a study have to be hospitalized, even thouse without any symptoms – in a time where we literally need every hospital bed for severe cases.

#22

Well, on March 24, Michigan’s lovely Gestapo…er, uh…I mean Governor… sent a letter to all doctors and pharmacists threatening administrative action if they prescribe or fill prescriptions for hydroxychloroquine and/or chloroquine as a treatment for the virus.

I understand the whole supply/production/demand issue - as well as the other illnesses that are treated with the drug- lupus, rheumatoid arthritis, malaria, etc…, so no lectures, please. Others need the drug for their illnesses. Consequently, Novartis and others have ramped up their production of the drug to help meet the increased needs. That is not the point of this post.

The concern, or rather the danger here is the insertion of governmental control (via threat) to the doctor - patient relationship. If a doctor sees a patient, deems said drug to be the best available option to treat an illness - then what? Treat the patient accordingly and risk losing their license? Or don’t treat the patient accordingly, and let them suffer or die? Pretty short options menu. In her letter, Wittmer urges pharmacists and doctors to turn in one another if they see prescriptions come through or- fill prescriptions for said drug IF it is for treatment of the virus. There are those who would say, “well, this is a an emergency executive action, and will only be for a short while.” To that, I say, “don’t be so sure”. There are those who believe in not letting a good crisis go to waste. You can read into that whatever you wish. I’m just sayin;…slippery slope we’re on now, folks. Be careful.

I

#23

Why is a governor making medical decisions for prescribed drugs? If a doctor wants to use a drug that has been on the market for decades then they should make the call. If myself or a family member is going to die and they want to try the drug to save me then I really hope that option is used. Decisions like this are 100% political…

#24

Exactly.

(Michael - When reality fails to meet expectations, the problem is not reality.) #25

@Fruno Maybe these guys know something you don’t.


(Utility Muffin Research Kitchen) #26

If you go by money spent on public opinion, we would all be eating chips&chocolate and drink sunflower oil :slight_smile: It’s certainly a nice gesture, but then: That’s just a bit of advertising for those companies. By keeping the stuff in the news they create demand, they will sell a lot more doses than that.

Mind you, I’d be very happy if this stuff works. But so far the data doesn’t back it up.

(Bacon is a many-splendoured thing) #27

It’s not an unreasonable guess that these drugs might help, but we need confirmatory data in order to know for sure. The problem is that experiments to yield such data take time, and people are feeling pressure to come up with a treatment immediately. It’s a tough ethical decision, whether to allow an unproven treatment in an emergency, particularly if it would take a necessary drug away from other patients. The reason the Food and Drug Administration came into existence in the U.S. in the first place was that people were spending enormous sums on treatments that were dangerous or that had no therapeutic effect.

Moreover, it is not helpful, in the current situation, to vilify administrators who are trying to do the best they can in an emergency. Yes, push for greater flexibility, but ultimately there is no point spending billions treating people with drugs that don’t work. If using these drugs off-label produces enough anecdotal evidence to suggest that they truly do—or do not—have an effect against the coronavirus/SARS-2, that is a whole different ballgame from where we stand at this moment, when we just don’t know. If we’re going to grasp at straws, let’s do so intentionally and reflectively, not unthinkingly.

(Michael - When reality fails to meet expectations, the problem is not reality.) #28

Data Dump. I’ve already linked several studies and reports on use of chloroquine and hydroxychloroquine above. Please read them before making unwarranted comments like “there’s no evidence” or “it doesn’t work”. Evey time this stuff is tried, it works. If you think there’s evidence that it does not, PLEASE CITE that evidence, not your opinion. Yes, of course, more and larger clinical trials are called for and will be done. In the meantime, the simple fact is many doctors all around the USA and other countries now prescribe these drugs off-label because they work. Thank you.




https://www.henryford.com/hcp/academic/medicine/divisions/id/hiv-consult/covid19


https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label


(Michael - When reality fails to meet expectations, the problem is not reality.) #29
(charlie3) #30

Apparently one of the effects of these medicines is to increase insulin sensitivity? They get in to that around 6:14 m

#31

These drugs look structurally similar to Vitamin B3. 500mg+ of Niacinamide(no flush) may work better without side effects.

https://academic.oup.com/cid/article/36/4/453/439703 Link may not work in chrome. Use firefox.

(Michael - When reality fails to meet expectations, the problem is not reality.) #32

Dr Fauci speaks again… and guess what?

… If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.2

Source

(Ethan) #33

Hospitalization is still clearly much higher rate—even if the fatality rate is lower than we think

(Utility Muffin Research Kitchen) #34

The number of dead people depends not only on the mortality rate, but on the speed of the infection and the base immunity. And all numbers of mortality are mostly taken from countries where patients were hospitalized. It will go up fast if we run out of beds and have to turn people away. You can’t reduce scientific facts to 160 characters.

Of the sources you cite, I discussed the french study in detail earlier. One is in vitro, which says nothing. There are plenty of drugs that work in vitro but not in a human trial. Another of your sources says “There is no current evidence from RCTs to recommend any specific anti-COVID-19 treatment for patients with suspected or confirmed COVID-19 infection.” Yep.

Anyway, guess it’s a moot point because we’ll find out in a month or two. From what we hear in Europe, not even NY is locked down. We can only pray that you are right and Hydroxychloroquine works, because we’re certainly screwed if it doesn’t.

A lot of the discussion reminds me of the demonization of cholesterol and saturated fats in the 60s. We’re making exactly the same mistakes again: Someone presents a plausible fact based supported only by a deeply flawed study, and we suddenly have a stampede following. Ignoring all the other options, before we know for sure that the direction is correct. That’s not how science works.

(Michael - When reality fails to meet expectations, the problem is not reality.) #35

@Fruno Many doctors, including most doctors in NYC are prescribing hydroxychloroquine because it works, not because they want to appear to be doing something useful. They’ve seen their patients respond well. Several countries have already publicly announced they are using it and recommending it. The hypothesis is being tested repeatedly and everywhere. So far no one has demonstrated it doesn’t work for a huge majority of patients. If you remain unconvinced, and want to await the RCT, New York State should have some preliminary results to announce soon. And we’re not necessarily screwed if chloroquine and hydroxychloroquine don’t work, other strategies are being examined as well.

(Utility Muffin Research Kitchen) #36

So far the death rates still rise quickly. Also we don’t know what kind of side effects survivors have, the one who had to go to ICUs. From SARS-1, a lot of the survivors ended up with chronic fatigue and the like. And even if hydroxychloroquine works, it’s clearly no mircacle drug like antibiotics where you may feel a lot better after a day. Patients will still need to be in ICU for a week, because in week 2 the disease morphes to an autoimmune disease and we do not have a drug for that yet. If we have a wave of infections, there won’t be enough ICU beds available. Somehow you seem to ignore these arguments. So it’s a good idea to avoid infection independent from death rates and drugs, independent from the availability of drugs. What will you do if half a million people are infected and you have 20k hospital beds?

But that’s only one side. A good scientist is one who will not choose a “yes” or “no”, but one who is aware that we are dealing with probabilities here. No one in the world really knows how well it works, not even doctors who use it. Let’s use some made up numbers. Say you think that hydroxychloroquine probably works, you’re 90% sure that it is efficient. If it doesn’t work, we’re looking at 100.000 deaths or more. Would you take that chance? Would you decide against a lockdown because we have a drug, and risk that 100.000 deaths are on your conscience?

End of discussion for me, we’re running in circles. You’re convinced that hydroxychloroquine works, I say there’s a high risk that it doesn’t, I don’t think we will convince each other.

(Doug) #37

I sure hope it does work for enough to make a real difference. We’ve got a compound interest type deal here, and if these drugs can whack off even a moderate amount along the way, the end result will be much different.

(Michael - When reality fails to meet expectations, the problem is not reality.) #38


Posted this link here as well:

(Utility Muffin Research Kitchen) #39

https://twitter.com/UnitedRda/status/1244299325963829248
“Unfortunately, we lost Dr.utpal barman a young anaesthesiologist died of sudden cardiac arrest this afternoon. He had just taken 2 doses of hydroxyl chloroquine.”

http://high-fat-nutrition.blogspot.com/2020/03/from-yeasts-to-chloroquine.html
“You can see that the drug chloroquine a) might work and b) might be very toxic in overdose.”

http://high-fat-nutrition.blogspot.com/2020/03/look-after-your-lysosomes.html
“Sadly the narrow line between the degree of raising lysosomal pH to blunt viral replication and that which might release sufficient cysteine to strip the FeS clusters out from complex I [where it becomes toxic] can be crossed quite easily, so it appears.”

(Michael - When reality fails to meet expectations, the problem is not reality.) #40