Hydroxychloroquine rated ‘most effective therapy’ by doctors for coronavirus:

[HarryStotle]

HarryStotle:

The point is that polls and anecdotal evidence could provide a legitimate or plausible indicator for which treatments ought to be peer reviewed — it narrows the field so to speak.

That is true. But that is not the issue. The issue in this thread is not over which drugs should be researched further. The issue is when it is appropriate to promote them to the general public. In particular, the poll in the OP is cited to compare HCQ with all other therapies, not to decide if HCQ (along with several other candidates) should be researched.

The poll provided an indicator of what doctors in the field have tried and would recommend for further research. None of those doctors nor did the site publishing the poll give the impression that peer review is thereby made unnecessary.

Again the poll provides researchers with a relatively reliable sense of which treatments ought to be further studied.

In times of war or pandemic, desperation means that possible treatments should and could be tried to stave of thousands of deaths if anecdotal evidence exists for the potential success of those treatments. Desperate times means formal protocol can be interrupted or at least altered to adjust to the desperate need.

That seems to be the point you are missing.

 

[LeafByNiggle]

The poll provided an indicator of what doctors in the field have tried and would recommend for further research.

Not a quantitative measure. As a quantitative measure such a poll is too affected by what is in the news already. And that, in turn, has been largely affected by Trump’s many many many many mentions of this one specific drug. Not fair.

This is not to say that HCQ should not the tried in desperate situations.

There are already double blind studies of HCQ underway and Remdesivir and perhaps others. No one is suggesting that they not be studied. So why is an additional push needed for HCQ?

 

[HarryStotle]

HarryStotle:

You are creating a false dichotomy here. There is no insistence that polls or anecdotal results ought to replace peer review (without acknowledging that peer review is itself necessarily infallibly reliable.) The point is that polls and anecdotal evidence could provide a legitimate or plausible indicator for which treatments ought to be peer reviewed — it narrows the field so to speak.

Otherwise, how would the researchers know which treatments ought to be researched further? You aren’t claiming that ought to be left to random selection are you?

No, the place to start is with those treatments that have some anecdotal or support from the field that they offer a reasonable chance to be proven by peer reviewed testing.

Oh dear! This is soooo not how the efficacy of a drug is evaluated. All that matter is cold, empirical data. And the best method we have to obtain such empirical data from human subjects is the double blind method. Even the treating physician should be kept in the dark during the study. So this poll is absolute nonsense from a scientific standpoint.

Not when people are dying all around you — cold, empirical data takes time that is not available.

The Korean War spurred a flurry of medical advances that didn’t rely on “cold, empirical data,” although that data was collected as treatments were tried on the front lines. The front lines didn’t wait for the data to be collected, however.

The Korean War also provided an opportunity to study and test new equipment and procedures, many of which would go on to become standards of care in both the military and civilian medical communities. These included vascular reconstruction, the use of artificial kidneys, development of lightweight body armor, and research on the effects of extreme cold on the body, which led to development of better cold weather clothing and improved cold weather medical advice and treatment. The newest antibiotics were used widely, and other drugs that advanced medical care included the anticoagulant heparin, the sedative Nembutal, and the use of serum albumin and whole blood to treat shock cases. In addition, computerized data collection (in the form of computer punch cards) of the type of battle and non-battle casualties was used for the first time. The extensive detail and accessibility of this data allowed for the most thorough and comprehensive analysis of military medical information yet.
Battlefield Medicine in the Korean War | Defense Media Network

Also:

Korean War - The History and Evolution of Wartime Medical Advances

6 battlefield medical innovations that moved to mainstream medicine

 

[Ridgerunner]

Yes, and the law firm ads we see on TV inviting people to join in the class action suits against manufacturers of those drugs found oh-so-perfect in double blind studies tell us the “scientific method” is a long way from being perfect.

And, of course, the vaccination that eventually wiped smallpox off the earth was judged effective by “anecdotal” evidence. People noticed that milkmaids often got sores from cowpox but never got smallpox.

Not saying science is a crock, but it’s not a golden idol worthy of worship either.

 

[Michaelangelo]

Not when people are dying all around you — cold, empirical data takes time that is not available.

Kindly point to a time when people have not been dying all around us? Inserting this level of subjectivity does nothing good for the process.

 

[HarryStotle]

HarryStotle:

The poll provided an indicator of what doctors in the field have tried and would recommend for further research.

Not a quantitative measure. As a quantitative measure such a poll is too affected by what is in the news already. And that, in turn, has been largely affected by Trump’s many many many many mentions of this one specific drug. Not fair.

This is not to say that HCQ should not the tried in desperate situations.

There are already double blind studies of HCQ underway and Remdesivir and perhaps others. No one is suggesting that they not be studied. So why is an additional push needed for HCQ?

No the problem isn’t that “No one is suggesting that they not be studied.” The problem is that some (perhaps not you) are saying that NO treatment that hasn’t passed rigorous study should even be tried.

I have no problem with tying the use of such treatments as HCQ or Remdesivir to formal research studies, but I also see the benefit in permitting qualified specialists to prescribe treatments when deaths are imminent or likely. I am also supportive of physicians recording results of treatments and sending those results into qualified studies even when the physicians themselves are not carrying out the “double blind” data collection, provide they follow strict treatment and data collection protocols.

 

[HarryStotle]

HarryStotle:

Not when people are dying all around you — cold, empirical data takes time that is not available.

Kindly point to a time when people have not been dying all around us? Inserting this level of subjectivity does nothing good for the process.

That is a silly point — the fact that people are dying all the time doesn’t mean there aren’t times when people are in far greater danger of dying than at other times. That isn’t a matter of “subjectivity” but of mathematics.

Why the heck aren’t you, then, faulting all the countries of the world for shutting down their economies based upon their “…nserting this level of subjectivity [that] does nothing good for the process.” You think that the numbers of infected and dying at this moment is indistinguishable from normal life, i.e., any other “…time when people have not been dying all around us”?

Strange how reality can be so easily denied to maintain an ideological point.

 

[LeafByNiggle]

LeafByNiggle:

HarryStotle:

The poll provided an indicator of what doctors in the field have tried and would recommend for further research.

Not a quantitative measure. As a quantitative measure such a poll is too affected by what is in the news already. And that, in turn, has been largely affected by Trump’s many many many many mentions of this one specific drug. Not fair.

This is not to say that HCQ should not the tried in desperate situations.

There are already double blind studies of HCQ underway and Remdesivir and perhaps others. No one is suggesting that they not be studied. So why is an additional push needed for HCQ?

No the problem isn’t that “No one is suggesting that they not be studied.” The problem is that some (perhaps not you) are saying that NO treatment that hasn’t passed rigorous study should even be tried.

I have no problem with tying the use of such treatments as HCQ or Remdesivir to formal research studies, but I also see the benefit in permitting qualified specialists to prescribe treatments when deaths are imminent or likely. I am also supportive of physicians recording results of treatments and sending those results into qualified studies even when the physicians themselves are not carrying out the “double blind” data collection, provide they follow strict treatment and data collection protocols.

I really have not seen a single post in this forum that is opposed to what you suggest here. Maybe there have been such posts and I just missed them. I don’t read every single post on CAF.

 

[HarryStotle]

I really have not seen a single post in this forum that is opposed to what you suggest here. Maybe there have been such posts and I just missed them. I don’t read every single post on CAF.

So we have agreement that physicians ought to be permitted some discretion to treat patients with either HCQ or Remdesivir — before double blind studies are completed — provided they follow strict protocols and collect reliable data for existing studies?

If so, then the question might be asked as to why should studies be done on those two drugs, in particular? Where does the justification come from for testing those two drugs if not “from the field” so to speak? It isn’t just “double blind” random thinking that spurs the researchers to select drugs for testing, is it?

Surely specialists have good reasons based upon what COVID does and how those drugs mitigate its effects? It isn’t as if the specialists are reading the polls and — without any clue regarding the virus or the drugs — thinking to themselves… “Hmmm, I have no clue why, but if that many doctors are trying it, maybe I should, too.” Do you suppose that is what moves specialists to try a drug: reading polls absent any other knowledge?

 

[LeafByNiggle]

If so, then the question might be asked as to why should studies be done on those two drugs, in particular? Where does the justification come from for testing those two drugs if not “from the field” so to speak?

Actually there are other ways. In the lab, these drugs can be tested in-vitro and in other animals for very little cost or risk. Often they just use the shotgun approach and try all sorts of things that way with little or no prior justification, and that is just fine because the cost and risk of such tests is so low. I would guess most drugs today start out this way. It is called screening tests. It is like sifting sand for fossils or panning for gold.

 

[Michaelangelo]

Yes, and the law firm ads we see on TV inviting people to join in the class action suits against manufacturers of those drugs found oh-so-perfect in double blind studies tell us the “scientific method” is a long way from being perfect.

Oh there is a whoooole world outside the US and the way your legal system works. And I’ve never claimed the double bind method or the scientific method are perfect, have I? But those are the best we have at the moment.

And, of course, the vaccination that eventually wiped smallpox off the earth was judged effective by “anecdotal” evidence. People noticed that milkmaids often got sores from cowpox but never got smallpox.

Yes anecdotal data was the origin that lead to the discovery of the smallpox vaccin. But it was not how the efficacy of the vaccin candidates were evaluated. See the difference?

Not saying science is a crock, but it’s not a golden idol worthy of worship either.

I fail to see how altar wroship has anything to do with this discussion. But you could perhaps enlighten me?

 

[Ridgerunner]

Yes anecdotal data was the origin that lead to the discovery of the smallpox vaccin. But it was not how the efficacy of the vaccin candidates were evaluated. See the difference?

The “evaluation” was that people observably didn’t get smallpox.

 

[Michaelangelo]

Michaelangelo:

HarryStotle:

Not when people are dying all around you — cold, empirical data takes time that is not available.

Kindly point to a time when people have not been dying all around us? Inserting this level of subjectivity does nothing good for the process.

That is a silly point — the fact that people are dying all the time doesn’t mean there aren’t times when people are in far greater danger of dying than at other times. That isn’t a matter of “subjectivity” but of mathematics.

Efficacy is not accurately evaluated by anecdotal evidence. It is as simple as that. But hey, my years in pharmacology mean diddly when everybody and their cat is an expert on everything on the internet today.

Why the heck aren’t you, then, faulting all the countries of the world for shutting down their economies based upon their “…nserting this level of subjectivity [that] does nothing good for the process.” You think that the numbers of infected and dying at this moment is indistinguishable from normal life, i.e., any other “…time when people have not been dying all around us”?
Strange how reality can be so easily denied to maintain an ideological point.

You are a bit fond of strawmen aren’t you?

 

[HarryStotle]

HarryStotle:

If so, then the question might be asked as to why should studies be done on those two drugs, in particular? Where does the justification come from for testing those two drugs if not “from the field” so to speak?

Actually there are other ways. In the lab, these drugs can be tested in-vitro and in other animals for very little cost or risk. Often they just use the shotgun approach and try all sorts of things that way with little or no prior justification, and that is just fine because the cost and risk of such tests is so low. I would guess most drugs today start out this way. It is called screening tests. It is like sifting sand for fossils or panning for gold.

That was done on both and both have been found effective.

Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro | Cell Discovery

We have recently reported that two drugs, remdesivir (GS-5734) and chloroquine (CQ) phosphate, efficiently inhibited SARS-CoV-2 infection in vitro1. Remdesivir is a nucleoside analog prodrug developed by Gilead Sciences (USA). A recent case report showed that treatment with remdesivir improved the clinical condition of the first patient infected by SARS-CoV-2 in the United States2, and a phase III clinical trial of remdesivir against SARS-CoV-2 was launched in Wuhan on February 4, 2020. However, as an experimental drug, remdesivir is not expected to be largely available for treating a very large number of patients in a timely manner. Therefore, of the two potential drugs, CQ appears to be the drug of choice for large-scale use due to its availability, proven safety record, and a relatively low cost.

 

[LeafByNiggle]

Notice that the “drug of choice” is based solely on current cost and degree of safety testing. Both of those issues could be addressed with the DPA. There is no quantitative indication of which (if either) drug is going to be clinically effective, meaning that it positively affects the outcome of patients.

 

[HarryStotle]

HarryStotle:

Michaelangelo:

HarryStotle:

Not when people are dying all around you — cold, empirical data takes time that is not available.

Kindly point to a time when people have not been dying all around us? Inserting this level of subjectivity does nothing good for the process.

That is a silly point — the fact that people are dying all the time doesn’t mean there aren’t times when people are in far greater danger of dying than at other times. That isn’t a matter of “subjectivity” but of mathematics.

Efficacy is not accurately evaluated by anecdotal evidence. It is as simple as that. But hey, my years in pharmacology mean diddly when everybody and their cat is an expert on everything on the internet today.

My cat is an expert on everything — and I rely on her fully to keep me informed. How perceptive of you.

So, could point out precisely where my cat is ill-informed?

Are you still suggesting drugs like remdesivir (GS-5734), chloroquine (CQ), or hydroxy-chloroquine (HCQ) should not be used AT ALL by physicians treating COVID-19 patients UNTIL all peer reviewed studies have been completed?

Is that your position?

I really have not seen a single post in this forum that is opposed to what you suggest here. Maybe there have been such posts and I just missed them. I don’t read every single post on CAF.

Perhaps we have “one post?”

 

[meltzerboy2]

Maybe this drug is better than the other options so far. That still does not mean it has the two essential features necessary to be marketed on a large scale: safety and efficacy. Further, who are all these medical professionals? What are THEIR qualifications with regard to pharmacology and virology?

Perhaps the medication can be used as an experimental drug with the consent of the patient or their family. But the danger is that it is produced in large quantities and prescribed as a matter of course before knowing its side effects and adverse effects, some of which have already been reported.

 

[LeafByNiggle]

Perhaps we have “ one post ?”

Which one? I still don’t see it.

 

[HarryStotle]

to be marketed on a large scale: safety and efficacy.

We aren’t speaking of marketing at the moment. We are speaking of use in the field when lives are potentially at stake.

 

[HarryStotle]

ETA is a few minutes.