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The MoA Week In Review – Open Thread 2020-41
Last week's posts at Moon of Alabama:
> In Brazil, 15 percent of deaths have been people under 50 — a rate more than 10 times greater than in Italy or Spain. In Mexico, the trend is even more stark: Nearly one-fourth of the dead have been between 25 and 49. In India, officials reported this month that nearly half of the dead were younger than 60. In Rio de Janeiro state, more than two-thirds of hospitalizations are for people younger than 49. … “It all points to social economic status and poverty,” Gray Molina said. <
> Let's see what the Washington-backed Hong Kong democracy really looks like. The man beaten in the video is a lawyer named Chan Tze-chin. He was attacked by the rioters because he did not support them on the street today. Hong Kong must rebuild the rule of law. < (video)
> The Hong Kong rioters vandalised a shop and steal a tee shirt from inside at causeway bay today < (video)
> Absolutely sickening. The West's beloved "freedom fighters" in Hong Kong stalk, surround and beat a defenceless young woman. While the West denounces China's new national security law, they are silent on the countless acts of such brutal violence. < (video)
Other issues:
Iraq:
Venezuela:
Electoral College:
Must read:
Use as open thread …
Odiferous Science at the Lancet
Did the good doctors of the recent Lancet study of chloroquine and hydroxychloroquine suddenly lose their sense of smell while treating patients with Covid-19? It sure seems like it, since their study has a phishy media smell to it. This is particularly serious given that the World Health Organization has decided to suspend their testing of hydroxychloroquine based on this rather flawed retrospective “observational” study.
Take it as you will, I’m not a doctor or a medical researcher, but it sure seems to me that the authors of the study would make better lawyers than healers or scientists. If I was to tell you that more than 70% of the deaths they reported in their study were among the control group, leaving less than 30% of the overall deaths to be divided among the four treatment groups they selected, I would be no less honest than the signers of the study. Indeed, using just the data reported in their study, it seems that 7530 deaths occurred among patients in their control group out of 10698 overall deaths, which comes to approximately 70.4% if you do the math yourself.
How can that be, you may wonder. Well, it seems there were more than 10 times the number of patients in the control group than there were in either of the four treatment groups. The authors apparently think it’s to their credit that they included 96032 patients in the study distributed among 671 hospitals in six continents. But among those 96032 patients, only 1868 received chloroquine without “macrolides”, 3783 chloroquine with “macrolides”, 3016 hydroxychloroquine without “macrolides”, and 6221 hydroxychloroquine with “macrolides”. The macrolides used in the study were either azithromycin or clarithromycin. So while they were at it, why didn’t they use six treatment groups instead of four, separating out the different macrolides among groups receiving the antimalarial medications chloroquine or hydroxychloroquine? Surely they had the data. Could this be hiding something? If there were more unpleasant outcomes in groups receiving one of the antibacterial macrolides versus those receiving the other macrolide, might that not have been an interesting observation? They make no comment about this.
But back to the numbers please. How many of the 671 hospitals reported patients using antimalarials. Was it 671, 67, or even fewer? Where were those hospitals located? We can’t really know without the raw data. Does it make sense to compare treatment groups in New York state or Hubei province against control groups in say Vietnam or Cambodia, where 0 deaths have been reported, or in Bahrain or Djibouti where only up to 14 deaths have been registered within the timeframe of the study. It doesn’t even make much sense to compare hospitalised patients between New York and Utah or Kansas unless the proportion of the treatment and control groups in those locations are similar, since the strains of the coronavirus and the treatment conditions in those locations are very different. The viral load of the predominant coronavirus strain in New York and New Jersey has been reported to be many times greater the viral load of the predominant strain in other US locations, and it seems safe to assume the conditions in the ICUs of New York and New Jersey are more hectic and stressful than conditions in the ICUs in the rest of the country.
The study authors claim they use data from patients who were hospitalised between December 20, 2019 and April 14, 2020. How many patients could they have included from 2019? I suppose we can guess from which hospital those would have been taken. But since the Covid-19 virus was not really identified until early January 2020, why did they decide to go back that far? Presumably those patients weren’t treated with antimalarials, but the authors do not tell us that.
There is no mention of zinc supplements in the study. Were they given to patients with the antimalarial treatments? The latter act as zinc ionophores, facilitating zinc uptake across cell membranes. It is the antiviral action of zinc that is presumed to be the main mechanism of the antimalarials against the coronavirus. Were zinc supplements given to the control patients with other zinc ionophores such as Quercetin or EGCG? If this information is not in the multinational registry used for the study data, the authors of the study do not tell us this.
The authors do mention mean daily dosage levels of the antimalarials, but they are a bit higher than the daily dosages recommended by other studies for coronavirus treatment (for example, 597 mg of hydroxychloroquine in the treatment group with macrolides with a standard deviation of 128 mg versus 400 mg recommended by doctors advocating hydroxychloroquine usage). Could this have caused the higher toxicity of the antimalarials noted in the study? Although the number of days treatment groups received antimalarials was apparently not significantly different from the standard treatment course of five days recommended by pro-hydroxychloroquine doctors, the mean reported was almost a day less, for example, 4.2 days in the group receiving hydroxychloroquine alone (without macrolides) with a standard deviation of 1.9, which gives a range of 2.3 to 6.1 days. Could those patients at the low end of the range really be said to have had a full course of treatment? Would the study results have been the same if these patients were excluded? The authors do not seem to think this is worthy of discussion.
Another interesting question is why patients with cardiac issues were included in the study results. It is well known that the antimalarials chloroquine and hydroxychloroquine are contraindicated for patients with heart failure and presumably arrhythmia, yet patients with existing “comorbidities at baseline” included 12137 patients (2061 in the treatment groups) with coronary artery disease, 2368 (419 in the treatment groups) with congestive heart failure, and 3381 (520 in the treatment groups) with arrhythmia. Since presumably the antimalarials should not have been given to these patients, does it really make sense to include them in the study unless you want to prove their toxicity? It would be nice to know how removal of these patients from the study might have changed the overall conclusions. The authors do not tell us.
Unfortunately the Lancet study has a distinct odor of Big Pharma propaganda, hardly hidden. The lead author notes, in what are considered “competing interests”, his receipt of personal fees from Abbott, Medtronic, Janssen, Mesoblast, Portola, Bayer, Baim Institute for Clinical Research, NupulseCV, FineHeart, Leviticus, Roivant, and Triple Gene. Isn’t it amazing how easily bad science can be used to discredit a potentially helpful treatment for persons suffering from the current coronavirus epidemic?
Posted by: dabizi | May 26 2020 7:54 utc | 120
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