THHuxleynew Verified User
  • Member since Jan 18th 2017

Posts by THHuxleynew

    Do you REALLY think that if Obama had made the same two statements as Trump, that the same negative political attitude towards HCQ would be seen?


    Yes. Doctors would have been incensed. The "we don't like Obama with racist undertones" thing would have been energised by it. If he had gone on to assert his opinion contrary to medical advice via twitter, re-tweeting those with contrary to medical opinion views (and who also incidentally has eccentric views on other subjects) it would have got bigger and bigger. Maybe it is only the left wing in the US that is inclined to dislike views contradicting medical advice, in which case it would not be so bad? But it would not be good. Politicians should stay out of medical matters.


    Of course any number of politicians might make unguarded comments about treatments. But when faced with medics disagreeing no-one except Trump would persist in maintaining a contrary public view through twitter.

    Bob - not sure if it helps. here is a non-politically-biassed (from Italy) recent review of the evidence on HCQ both RCT and observational.


    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351664/


    Results

    Thirty-two studies were included (6 RCTs, 26 nonrandomized, 29,192 participants). Two RCTs had high risk, two ‘some concerns’ and two low risk of bias (Rob2). Among nonrandomized studies with comparators, nine had high risk and five moderate risk of bias (ROBINS-I). Data synthesis was not possible. Low and moderate risk of bias studies suggest that treatment of hospitalized COVID-19 with CQ/HCQ may not reduce risk of death, compared to standard care. High dose regimens or combination with macrolides may be associated with harm. Postexposure prophylaxis may not reduce the rate of infection but the quality of the evidence is low.

    Conclusions

    Patients with COVID-19 should be treated with CQ/HCQ only if monitored and within the context of high quality RCTs. High quality data about efficacy/safety are urgently needed.

    If I contract Covid, can you tell me definitively why I should NOT take HCQ+Zinc and Ivermectin?


    I thank God I'm not doctor so don't have the responsibility of deciding what you should take. If it were me, now, I'd not take HCQ nor Ivermectin unless a doctor told me to do so.

    IMO the decision should be left in the hands of the doctor patient relationship, and you, it seems, prefer higher authorities to make those decisions for them.


    I'm not saying that. I prefer doctors to be responsible and have power. it is just tough for them in exceptional times like this when in the midst of people dying like flies, and convinced a drug will help, it is difficult not to give this even when your belief is that it will do harm.


    Normally doctors handle this sort of thing. HCQ has got so politicised by Trump and then others that it is a tough one.


    THH

    First, if taken under a doctors oversight and tested first, HCQ has no serious side effects.


    Bob - I've said this before but it is quite a complex point.


    COVID can (normally) have no serious side effects but still (as the RCT evidence points to, slightly) increase disease severity in COVID patients. Why?


    Because it is both anti-viral and immunomodulatory active. Suppose the anti-viral effect does not help, for example it is given to patients in hospital who have been infected more than 5 days ago. Then in second stage COVID the way it alters the immune system could make things better or worse - but it looks based on data so far as though it makes things worse. In that case having it in your system is a v bad idea. It persists in the body for a long time, so you cannot just stop taking it when you know you have caught COVID.

    At least you admit it is still a debate as to whether or not HCQ has benefits re COVID. Unfortunately, the media, social media, WHO, and many developed nations health agencies, left wing politicians,.. all have concluded the issue is resolved, and the debate over. HCQ is so dangerous to use according to them, that it has either been outright banned, or been so politicized it is as good as banned.


    Pains me to see Gates jumping on that bandwagon. I respect the man, and for him to take sides against common sense, and the truth (HCQ is safe), only makes me curious about his motivations. Something I never questioned before.


    Let me ask you this; was the reaction to HCQ justified? While the facts are being sorted out, should it still be fully available to doctors, and their patients?


    I think the medical conclusion at the moment (does not work as treatment) is correct. Should therefore doctors be saved from the demands of politically motivated patients by banning them from prescribing. I'm not sure. You can argue it both ways. Not banning gives doctors a lot of responsibility, and puts them in a tough position. Overall it would mean more people die, but probably not a lot more.


    I'm not sure that anyone is stopping people from doing prophylactic tests - or indeed any sort of tests. I'm all for that but don't see HCQ as the best bet for testing given its lack of success so far.


    One difference between me and others is having looked at a lot of non-RCT evidence, and tried to judge it, I can see that it is almost impossible to get sensible data from it. COVID mortality is just too variable dependent on other factors. The front-line doctors who think a treatment is good will use it, and therefore never have proper comparative data to know whether it is actually good.

    Are you an anti-vaxer? Take this simple test to find out. Higher score indicates stronger anti-vax tendencies.


    Do you:

    (1) read medical science theories that while qualitatively correct have no evidence that they are quantitatively significant overall?

    (2) take no interest in quantitative work judging significance of such ideas?

    (3) ignore the fact that vaccines get better over time (e.g. new ones, like those for COVID) that are good at engendering T-cell immune response?

    (4) read weird conspiracy theory websites that claim Bill Gates engineers pandemics and Microsoft wants to control the world by implanting chips into everyone? No, you don't believe all of it but you like reading it and darkly suspect there must be some truth there, given how much you hate Gates

    (5) deny (contradicting the heroic work, ever since SARS and MERS, of the Gates foundation and the thinking medical establishment) that respiratory disease pandemics are the most likely short-term threat to our health and livelihoods?

    (6) stir up FUD that makes a significant portion of the US population unlikely to accept vaccines as the (only good) solution to bad new respiratory pandemics, and therefore reduces prospects for medium solution to COVID probelms.

    All of these is what "saved the world" not vaccines. The data is vast and obvious, go read it.


    Again - Navid you claim to be interested in science and yet you don't give scientific (quantitative) evidence to support your PR.


    You posit various possible reasons why the better health results that have come with vaccines might be due to other things. Fair enough. But that does not prove anything, just means you need to look carefully at the data and do science not PR.


    When I post exactly that - a paper showing that even counting the other effects vaccines still reduce overall mortality - you go all indignant and ask mods to ban me for posting spin.


    Let us (as you say) settle this once and for all:


    (1) Yes - I agree there are all sorts of second-order effects that mean vaccines overall many not be as good for populations as the headline efficacy rates imply

    (2) Vaccines do however generally give herd immunity, if taken by high percentage of population

    (3) Vaccines can induce T-cell response just like infection - those that do are more effective against high mutation rate viruses (and COVID). Modern vaccines do this.

    (4) When fair statistical techniques are used vaccines confer strong whole population benefits

    2) Natural infections give T cell immunity. This gives you cross protection to other flu strains(CD8 immunity). They lower viral shedding by 2/3.


    Sigh.


    Oxford COVID Vaccine - T-cell response

    https://www.ox.ac.uk/news/2020…es-strong-immune-response


    (Newer) Flu vaccines have strong T-cell response

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192353/


    I'm not denying natural infections give T-cell immunity - if they don't kill you - just saying vaccinations do now too!


    THH

    I think the board admins can see this clear example no real interest in serious debate. My post was immunological not numbers.


    I'm interested in immunology too. The problem is that only empirical data can tell how significant the speculative theoretical effects actually are. I can see that for you a nice theory trumps (no - I promise - no pun intended) science.


    A good analogy would be a clever scientist in the times of Pasteur questioning the paradigm of antibiotic use because of development of resistance, or destruction of gut bacteria. True, in theory, but a much healthier 20th century tells you we are still better off with antibiotics than without, even though now we are really starting to see the effects of resistance that 50 years of over-prescribing have made.

    W - you assert that:


    Many people get more sick from vaccine than Flu.


    Would you care to qualify this ambiguous statement and remove the spin?


    1. If you mean in the population - then it is both true and profoundly stupid. Why bother saying it? Obviously everyone who does not get Flu and does get vaccinated will get more sick from vaccination than Flu. even if only from the pain of a needle prick. I did you the credit of assuming you were not making obviously irrelevant remarks like this, but if you wish to assert this now i will agree with you and point out that you are guilty of spin - saying something that sounds good but is meaningless


    2. If you select for "those who are vaccinated (on the one hand) or have Flu without vaccine (on the other)" We are now comparing vaccine side-effects with Flu. In a large population there will be a very few people with severe vaccine side effects, for whom those are worse than Flu. If you call this "many" when it is a miniscule fraction (I estimate < 0.1%) of the total, then again i will allow you your point, but also point out you are guilty of spin.


    3. If, finally, you mean that there are many people who are vaccinated, have side effects, then (the same people) catch mild Flu, and the flu is less bad than the side effects. This is interesting. I still assert that even mild Flu is worse than nearly all of the vaccine side effects. Only 1-2% of people given the vaccine end up with a temperature, and it lasts for at most 1-2 days - if I remember right from a US side effect description. BUT it is apples with pears. Vaccinations reduce the severity of Flu even when they do not prevent it, so these same people without the vaccine might have got much more severe Flu.


    Thank you for highlighting the extreme ambiguity of your comment. Now choose: are you, with this statement, an anti-vaxer (peddling lies) or a spin doctor saying things that are misleading but true?


    THH


    Numbers are needed to estimate these effects. And your post has NO NUMBERS.


    Here is a sophisticated analysis, which I think includes all of your speculative "bad effects" of vaccines. Flu vaccination still wins (not by as much as would be the case given a naive analysis).


    https://academic.oup.com/aje/article/170/5/650/102527


    Method:


    To differentiate vaccine effects from bias, we traced the vaccination-mortality association day by day—before, during, and after flu season—at Kaiser Permanente in Northern California. The usual strategy for minimizing bias is to seek good measures of potential confounders and then adjust for them. However, usually it is not feasible to track weekly changes in frailty and function as they attenuate the propensity to obtain flu shots near the end of life.

    Our alternative strategy was to focus on a “difference in differences” (this term and general approach are often used by economists (16)). If the flu vaccine really does prevent deaths, then in a large population there should be a detectable difference between 2 differences: 1) the difference in the odds of prior vaccination between decedents and survivors that is observed on days when flu is circulating and 2) the difference in the odds of prior vaccination between decedents and survivors that would be expected on the same calendar dates if flu were not circulating. To examine such a difference in differences (or the corresponding ratio of odds ratios), we fitted a logistic regression model with a novel case-centered specification.

    Our goals were to: 1) examine the propensity to obtain a flu shot in relation to predictors of mortality, 2) estimate the effect of flu shots on mortality, and 3) present and discuss case-centered logistic regression.


    Results:



    We found that flu shots reduced all-cause mortality among elderly Kaiser Permanente members by 4.6% during 9 laboratory-defined flu seasons in Northern California. Other researchers have reported that flu shots reduce mortality by much greater amounts. In a meta-analysis of results from 20 cohort and case-control studies, Voordouw et al. (6) found that flu shots reduce winter deaths by 50%, on average; and in a more recent study, Nichol et al. (19) reported a 48% reduction in all-cause mortality among the elderly during flu season. However, Simonsen et al. (11, 12, 20) found that excess mortality attributable to influenza has only been 5%–10% on average during flu seasons in the past several decades. They argued that flu shots could not possibly have prevented more deaths than the 5%–10% of deaths that were flu-related (11–13). Our estimate of excess mortality during flu season was 7.8%, which is consistent with Simonsen et al.’s nationwide estimate but lower than estimates made by others (21–23).

    This excess mortality of 7.8% is what we found in a population with over 60% vaccine coverage. Our findings suggest that had none of the elderly been vaccinated, excess mortality during flu season would have averaged about 9.8%. We infer that our 4.6% VE estimate amounts to a 47% reduction (4.6/9.8 = 47%) in the number of flu-attributable deaths that would have occurred had none of the elderly been vaccinated.


    Best wishes,


    Don't forget to get your Flu jab!


    THH

    Stats for prophylactic dosing.


    You are 70 year-old man (say).


    Your mortality estimate if you get COVID (as defined by symptoms) is 5%. (I don't guarantee this is correct - it is difficult to calculate).


    You live in a very high-risk COVID area - in the end:


    60% in your area will have caught the disease. Of those, 30% will clear it with T-cell immunity.

    30% of the population will be seropositive. of those 15% will have no or minimal symptoms.

    15% however will have obvious symptoms.


    So your chances of dying are 0.75%, and say 0.75% again of being seriously disabled but not dead.


    1 in 70 chance of a very nasty result.


    What chance of severe harm from the drug to you accept for:

    (1) a one-off vaccine shown based on extensive testing to have 50% efficacy for your age group?

    (2) a prophylactic drug that might be efficacious - but no-one knows what are the chances of this?


    Obviously you can brew your own numbers here - this is only an example...


    Statistical caveat. This calculation underestimates your risk by up to 4X! Why?


    It is likely that both T-cell immunity and "minimal symptom" seropositive COVID correlate negatively with age. So a 70 year old will be less likely than typical to be T-cell immune or asymptomatic.


    It is really difficult to be confident about these risk estimates, even knowing all we do now.


    (EDIT - 30% seropositive is 2X London - the hardest hit part of the UK).

    https://www.thelibertybeacon.c…s-but-offers-no-evidence/

    "Bill Gates this week added more flame to the fire in the ongoing debate over the usage of hydroxychloroquine to treat COVID-19, claiming that using the drug to treat the coronavirus carries with it the risk of “severe side effects” and arguing that medical officials should instead pursue the numerous “good therapeutic drugs” currently in development.

    Yet there is at present little evidence that “severe side effects” are common in COVID-19 patients who take hydroxychloroquine, with the majority of reported adverse events being relatively mild and only a small fraction of reported effects so far being dangerous and/or fatal."


    Shane, I know probability is one of those geeky things you reckon red-blooded men should not dirty their hands with but...


    Gates was saying there is a risk of severe side effects, not that severe side effects are common. The disagreement is on how much, if any, benefit you get from taking HCQ. I agree that if it were shown to be effective at prevention - say even as much as Flu vaccine - doctors could dose everyone prophylatically in high COVID areas. That is because unlike the anti-vaxers (RB please note the extra helping of spin here) I accept small risks of serious side effects for overall benefits. I'm not sure most doctors would agree. Primum non nocere (within risk/reward limits).


    One weirdness in the "political" aspect of this debate. The same people who are negative about risk/reward of very thoroughly tested vaccines are positive about the risk/reward of unproven prophylatic drugs! Interested to hear comments from those here this applies to - maybe I am wrong? Gates is also an example of this contradiction - except he would claim that vaccines are much, much, safer than HCQ, and also that vaccines are much more efficacious than HCQ. Anyone want a careful discussion of this? I think we really can't yet know how effective is HCQ at prophylaxis. One think we do know, HCQ would not be a permanent solution because of the long term retinotoxicity.