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Mrs Whiggins

CR: COVID-19 --Political Talk

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1 hour ago, Sbbruin said:

This may sound awful wishing death on someone, but a part of me hopes Gohmert dies of the rona to hopefully drive some sense into the mak deniers.  Honestly I don't know if it would have any impact, but maybe, just maybe, people will start waking up.

It won't do a thing. He thinks he got it from wearing a mask, so that's what they'll believe, strengthening their resolve.
They are gung ho on demon sperm chick, so I don't know that his death is gonna help, science isn't really their thing.

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1 hour ago, Sawbonz said:

I really don’t understand why no RCT has looked at the cocktail of HCQ zinc and azithromycin when literally every case I know of personally or have heard about through the grapevine is using it that way. 

Health Canada and FDA would not allow the Azith combo in the trials due to the QT concerns.

What was the age range and risk profile of the physicians involved.  I know that we are talking case studies here, but do you observe a trend in any potential confounders in that series of 4?

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1 hour ago, FondrenRoad said:

Because Peter Navarro didn't stockpile millions of doses of azithromycin.  Also, having shitstains hoard antibiotics is the last thing we need.  It shouldn't be legal with HCQ either.

How many people with lupus have been unable to get HCQ since this shit started?

So those are your reasons not to run an RCT on a cocktail that retrospective analyses have shown may be effective vs covid?

Seems if you want to curtail inappropriate use of a drug because it’s ineffective you should, you know, show that it’s ineffective in the way it is actually being used. 

How many clinical trials have you designed?
 

 

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16 hours ago, Irwin F Fletcher said:

Who gets the Rona next? No mask dude or chin mask dude?54b11a213e34c08d062380fee02e85d0.jpg

In this world? Everybody in the photo except those two.

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5 minutes ago, Anastasis said:

Health Canada and FDA would not allow the Azith combo in the trials due to the QT concerns.

What was the age range and risk profile of the physicians involved.  I know that we are talking case studies here, but do you observe a trend in any potential confounders in that series of 4?

That’s the problem you can’t say shit about an n of 4. The one that wound up intubated was early 60s and fit. 2 were early 40’s and fit. The one diagnosed this week is late 40’s a little heavy but no medical conditions. 
 

 

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Posted (edited)
17 minutes ago, Sawbonz said:

So those are your reasons not to run an RCT on a cocktail that retrospective analyses have shown may be effective vs covid?

Seems if you want to curtail inappropriate use of a drug because it’s ineffective you should, you know, show that it’s ineffective in the way it is actually being used. 

How many clinical trials have you designed?
 

 

https://clinicaltrials.gov/ct2/show/NCT04370782

You mean like this one?  

I am on board with testing any possible treatment that shows promise. Are you on board with seizing these medications from hoarders?

 

Edited by FondrenRoad

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6 minutes ago, FondrenRoad said:

https://clinicaltrials.gov/ct2/show/NCT04370782

You mean like this one?  

I am on board with testing any possible treatment that shows promise. Are you on board with seizing these medications from hoarders?

 

Has this study enrolled anyone yet? I remember seeing this posted initially but haven’t heard anything else since

who are the hoarders?

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2 hours ago, Sbbruin said:

This may sound awful wishing death on someone, but a part of me hopes Gohmert dies of the rona to hopefully drive some sense into the mak deniers.  Honestly I don't know if it would have any impact, but maybe, just maybe, people will start waking up.

Part of you? All of me hopes it. He deserves it. And like you said, maybe people will learn from it. Better late than never when the Trumpublican Party has been slow rolling their response to the pandemic for months and costing Americans their lives. 

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2 minutes ago, Anastasis said:

  

While technically a randomized, controlled trial, there is no standard of care/placebo group. This will not be particularly informative to teh question at hand. 

Well, we are in the midst of a pandemic and there is/was no known effective treatment.  A placebo group in that situation would be unconscionable.

In studies for new stage 3 cancer drugs is there an untreated control group, or does the control group get treated with currently approved medications?

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Posted (edited)
27 minutes ago, Sawbonz said:

That’s the problem you can’t say shit about an n of 4. The one that wound up intubated was early 60s and fit. 2 were early 40’s and fit. The one diagnosed this week is late 40’s a little heavy but no medical conditions. 

I know that you were not pressing the case series as definitive. Given what we have seen in outcomes by age, that jumps out. 

Like Fondren, I am not opposed to conducting further research on the combos. But we also need to recognize exactly how much trial bandwidth has been spent chasing HCQ with nothing close to confirming the early signals to show from it.  Subjects are the currency that trials run on.  "We" have spent a lot of currency chasing HCQ with nothing substantive to show for it.  At some point we have to move on to the many other candidate therapies. 

Here is a twitter thread from an ID pharmacist that lays out the HCQ history here from in vitro studies, to animal studies, to clinical trials. It does not touch on Azith or Zn though, granted.

 

And an article that discusses how the haphazard approach to COVID research has been shooting ourselves in the foot.

https://www.statnews.com/2020/07/06/data-show-panic-and-disorganization-dominate-the-study-of-covid-19-drugs/

 

For instance, 237,000 patient volunteers were to be enrolled in studies of hydroxychloroquine or chloroquine. That’s 35% of the 685,000 patient volunteers whom researchers hoped would be enrolled in any study. Since patients willing to enter studies are one of the scarcest resources in medicine, this means that other potential treatments, such as ivermectin or favipiravir, were not studied.

 

Edited by Anastasis

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4 minutes ago, Sawbonz said:

Has this study enrolled anyone yet? I remember seeing this posted initially but haven’t heard anything else since

who are the hoarders?

Of HCQ?  There are loads of hoarders.  But the administration led by Navarro is the biggest one, and it has caused a shortage of it for those who need it for lupus and arthritis that has been widely reported.

I'm not sure whether they have enrolled anyone in the study.  They were using that treatment protocol when the outbreak was occurring in NY, however.   At this point, there aren't enough potential new patients near St Francis hospital to reach the 750 participants needed.  So if they didn't start in April, they likely won't start until/if there is a fall outbreak in NY.

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Posted (edited)
20 minutes ago, FondrenRoad said:

Well, we are in the midst of a pandemic and there is/was no known effective treatment.  A placebo group in that situation would be unconscionable.

In studies for new stage 3 cancer drugs is there an untreated control group, or does the control group get treated with currently approved medications?

Standard of care is completely ethical as a comparison group in this setting, and has been approved specifically for HCQ studies.

As far as HCQ alone with HCQ + Azith, here is a randomized study from Brazil.  3 arms: standard of care, SOC + HCQ, SCO + HCQ/Azith. Results: Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care. 

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

Edited by Anastasis
link

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10 minutes ago, Anastasis said:

For instance, 237,000 patient volunteers were to be enrolled in studies of hydroxychloroquine or chloroquine. That’s 35% of the 685,000 patient volunteers whom researchers hoped would be enrolled in any study. Since patients willing to enter studies are one of the scarcest resources in medicine, this means that other potential treatments, such as ivermectin or favipiravir, were not studied.

This seems really, really, really fucking important.

We have a finite pool (yeah, it's big....but still finite) of infected people on which we can run treatment trials.  If we use them all up on a trial of the curative powers of daily doses of M&Ms, then we don't have patients to use for trials of.....any number of other therapies that are more likely to actually help.

We're burning up our trial pool on HCQ, so we can't study things like invermectin, which are actually promising.  Is that what's actually happening?  @Anastasis ?

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Posted (edited)

Basically there are no level one studies of HCQ Zinc and azithromycin. And the one that would have been close (not blinded) is dead in the water. The honest thing to say is we don’t know if the cocktail works or not. If you don’t want to expend scarce resources to find out fine, but quit pointing to  HCQ only studies to justify it
 

Because of the nature of my specialty we often don’t get level 1 studies. We will use level 2 and even occasionally level 3 studies to guide treatment because it’s the best we have. What I have never seen is an attempt to use level 1 data showing procedure X when performed alone is ineffective to say you shouldn’t perform combo procedure XYZ. 
 

eta I have no opinion as to whether the cocktail works. I’m pointing out it hasn’t been studied

Edited by Sawbonz

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2 hours ago, Francisco 2.0 said:

Shit, the deniers wouldn't believe it.  They (Q) would jump in how it was a conspiracy and Gohmert was murdered in some fashion, and "blamed' on Covid.

 

 

Quoting myself,  because it didn't take long.

She's running for John Lewis' seat in Georgia:

 

 

 

 

 

 

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2 hours ago, Francisco 2.0 said:

Shit, the deniers wouldn't believe it.  They (Q) would jump in how it was a conspiracy and Gohmert was murdered in some fashion, and "blamed' on Covid.

 

 

Quoting myself,  because it didn't take long.

She's running for John Lewis' seat in Georgia:

 

 

 

 

 

 

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13 minutes ago, Sawbonz said:

Because of the nature of my specialty we often don’t get level 1 studies. We will use level 2 and even occasionally level 3 studies to guide treatment because it’s the best we have. 

I know I could google this, but I'll short circuit that process:  can you explain the difference between the study levels?

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35 minutes ago, Anastasis said:

I know that you were not pressing the case series as definitive. Given what we have seen in outcomes by age, that jumps out. 

Like Fondren, I am not opposed to conducting further research on the combos. But we also need to recognize exactly how much trial bandwidth has been spent chasing HCQ with nothing close to confirming the early signals to show from it.  Subjects are the currency that trials run on.  "We" have spent a lot of currency chasing HCQ with nothing substantive to show for it.  At some point we have to move on to the many other candidate therapies. 

Here is a twitter thread from an ID pharmacist that lays out the HCQ history here from in vitro studies, to animal studies, to clinical trials. It does not touch on Azith or Zn though, granted.

 

And an article that discusses how the haphazard approach to COVID research has been shooting ourselves in the foot.

https://www.statnews.com/2020/07/06/data-show-panic-and-disorganization-dominate-the-study-of-covid-19-drugs/

 

For instance, 237,000 patient volunteers were to be enrolled in studies of hydroxychloroquine or chloroquine. That’s 35% of the 685,000 patient volunteers whom researchers hoped would be enrolled in any study. Since patients willing to enter studies are one of the scarcest resources in medicine, this means that other potential treatments, such as ivermectin or favipiravir, were not studied.

 

If you keep this shit up triple's going to chime in.  It's like saying Beetlejuice 3 times.

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15 minutes ago, Sawbonz said:

Basically there are no level one studies of HCQ Zinc and azithromycin. And the one that would have been close (not blinded) is dead in the water. The honest thing to say is we don’t know if the cocktail works or not. If you don’t want to expend scarce resources to find out fine, but quit pointing to  HCQ only studies to justify it
 

Because of the nature of my specialty we often don’t get level 1 studies. We will use level 2 and even occasionally level 3 studies to guide treatment because it’s the best we have. What I have never seen is an attempt to use level 1 data showing procedure X when performed alone is ineffective to say you shouldn’t perform combo procedure XYZ. 
 

eta I have no opinion as to whether the cocktail works. I’m pointing out it hasn’t been studied

What are the standards for a study in the current climate (finite pool of guinea pigs as mentioned above)?

There are countless combination treatments that haven't been proven not to work. What I'm asking is why you think that combination XYZ should be studied when there have already been studies showing X doesn't work and XY doesn't work. What about zinc would cause such a major difference when added to HCQ and azithromycin? There should be some sort of known interaction there but I haven't read it yet. 

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7 minutes ago, jimmyjazz said:

I know I could google this, but I'll short circuit that process:  can you explain the difference between the study levels?

Level of evidence (LOE)

Description

Level I

Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.

Level II

Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT).

Level III

Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).

Level IV

Evidence from well-designed case-control or cohort studies.

Level V

Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).

Level VI

Evidence from a single descriptive or qualitative study.

Level VII

Evidence from the opinion of authorities and/or reports of expert committees.

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6 minutes ago, jimmyjazz said:

I know I could google this, but I'll short circuit that process:  can you explain the difference between the study levels?

I don't have time to go into detail but here's a good summary. Basically the higher the level of evidence the lower the likelihood any measured difference in the groups is due to chance or error

 

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So my seattle based company has been pretty steadfast on not requiring anyone back into the office before October 9 for awhile now. Today they just updated that date to Jan 4.  I expect they are following the lead of companies like MSFT and Amazon in the PNW, so it looks like business is fully expecting no major changes here through the rest of the year now.  Fuck.

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Just now, NameAlreadyInUse said:

So my seattle based company has been pretty steadfast on not requiring anyone back into the office before October 9 for awhile now. Today they just updated that date to Jan 4.  I expect they are following the lead of companies like MSFT and Amazon in the PNW, so it looks like business is fully expecting no major changes here through the rest of the year now.  Fuck.

I got word last month to plan on working from home for the rest of the year. I sprung for a few home office upgrades, definitely worth spending a few hundred bucks on an actually good chair

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FYI, when I took Drug Study Design during my PharmD coursework back in the early to mid 90's, the faculty was from McMaster University in Canada. Guyatt is the guru. There is a systematic approach to evaluating the base of evidence to inform practice. 

As has been mentioned here, sometimes you don't have good RCTs to inform practice. You do your best with extant data. If you are a well-trained clinician, you use your experience, intuition, and things you learned from pedagogic teachings to fill in the gaps.

Now here's the thing. If you DO have good RCTs that point in one direction, but you want to bend towards a bias (wherever the bias comes from, ie cute sales rep), you deserve whatever malpractice suits and negativity headed your way...especially when your patients are harmed.

All this said, in the absence of effective, curative medicines, there are numerous strategies clinicians must employ. There's no question that politics has entered the arena on this approach, which is unfortunate because some clinicians are still trying to do their best with what they have in front of them.

Bottom line: multiple RCTs demontrated no benefit of HCQ, which outweighs the supportive evidence base, which consists of zero blinded, well-designed RCTs that I can find. If the scientific community can sort through everything learned thus far regarding HCQ, I have no issue with informing new strategies to be tested via adequately powered, well designed RCTs, although Anastasis make a good point about the competition between studies and the precious resource of how many eligible patients are proximal to qualified research sites.

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Posted (edited)
25 minutes ago, Huckleberry said:

What are the standards for a study in the current climate (finite pool of guinea pigs as mentioned above)?

There are countless combination treatments that haven't been proven not to work. What I'm asking is why you think that combination XYZ should be studied when there have already been studies showing X doesn't work and XY doesn't work. What about zinc would cause such a major difference when added to HCQ and azithromycin? There should be some sort of known interaction there but I haven't read it yet. 

If I give you a 3 legged stool and say hey these are great for siting and you take 2 legs off, try sitting on it and fall on your ass, do you think you gave my furniture a fair trial?

I give you another and you take 1 leg off, try sitting on it, and still fall on your ass, is that any better?

Again, I have no opinion on whether the cocktail works, and I'm no more in the know than any of you on the proposed mechanism of action between the 3. I only know that this treatment regimen has evolved and is persisting.  If you want to make a case for or against it you need to actually study it.  I'm also OK with abandoning it due to the scarce resources argument, but I'm not treating covid and I'm trying not to become a patient so I'm not really who needs to be convinced

 

 

ETA I am not trying to push HCQ either alone or in combo. I try never to get on facebook, but have been sucked in a few times by people posting about how HCQ is the cure and the libs and celebs are trying to hide it from the "good" people. I explain in no uncertain terms there are no good studies to show a benefit to HCQ either alone or in combination. Occasionally people actually listen

Edited by Sawbonz

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2 hours ago, DigDug said:

Like everyone else the human side of me says I should show empathy towards his plight and his family, but right now I just can’t.

He was an asshole, and this country is in the predicament it is in because of assholes all around just like him. 

I am in no way rooting for people to die, but truthfully Fuck’em.  The hoaxers and Q dipshits have put thousands and thousands of other people at risk without giving a damn.

And they wouldn't have cared if it happened to you or someone in your family.  

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Posted (edited)
16 minutes ago, Sawbonz said:

If I give you a 3 legged stool and say hey these are great for siting and you take 2 legs off, try sitting on it and fall on your ass, do you think you gave my furniture a fair trial?

I give you another and you take 1 leg off, try sitting on it, and still fall on your ass, is that any better?

Again, I have no opinion on whether the cocktail works, and I'm no more in the know than any of you on the proposed mechanism of action between the 3. I only know that this treatment regimen has evolved and is persisting.  If you want to make a case for or against it you need to actually study it.  I'm also OK with abandoning it due to the scarce resources argument, but I'm not treating covid and I'm trying not to become a patient so I'm not really who needs to be convinced

I'm not going to try to copy/paste due to formatting issues, but here's a link to an interesting article discussing the putative MOA of HCQ +/- AZ, along with a Table summarizing evidence to date. It's quite interesting. Unfortunately it's only got two legs of the proverbial tripod (can't speak for Zn).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280673/

 

Edited by PsychMike

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13 minutes ago, Sawbonz said:

If I give you a 3 legged stool and say hey these are great for siting and you take 2 legs off, try sitting on it and fall on your ass, do you think you gave my furniture a fair trial?

I give you another and you take 1 leg off, try sitting on it, and still fall on your ass, is that any better?

Again, I have no opinion on whether the cocktail works, and I'm no more in the know than any of you on the proposed mechanism of action between the 3. I only know that this treatment regimen has evolved and is persisting.  If you want to make a case for or against it you need to actually study it.  I'm also OK with abandoning it due to the scarce resources argument, but I'm not treating covid and I'm trying not to become a patient so I'm not really who needs to be convinced

 

 

ETA I am not trying to push HCQ either alone or in combo. I try never to get on facebook, but have been sucked in a few times by people posting about how HCQ is the cure and the libs and celebs are trying to hide it from the "good" people. I explain in no uncertain terms there are no good studies to show a benefit to HCQ either alone or in combination. Occasionally people actually listen

Your analogy makes no sense. A 1 legged stool can be proven to provide more support than a "stool" with no legs. A 2 legged stool can be shown to be much more stable than a stool with no legs and also more stable than a stool with 1 leg. Those findings would make a 3 leg test an obvious logical progression.

In our case, X was found to be no more effective than nothing (per the study that @Anastasis posted). XY was found to be no more effective than nothing. So there needs to be a good reason to expend resources on XYZ and nobody has presented any that I know of. If there is a chemistry-based reason for XYZ to be considered wholly different than X and XY then I'm just asking to understand what that is. Otherwise there doesn't appear to be a reason to study it.

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Posted (edited)
17 minutes ago, Huckleberry said:

Your analogy makes no sense. A 1 legged stool can be proven to provide more support than a "stool" with no legs. A 2 legged stool can be shown to be much more stable than a stool with no legs and also more stable than a stool with 1 leg. Those findings would make a 3 leg test an obvious logical progression.

In our case, X was found to be no more effective than nothing (per the study that @Anastasis posted). XY was found to be no more effective than nothing. So there needs to be a good reason to expend resources on XYZ and nobody has presented any that I know of. If there is a chemistry-based reason for XYZ to be considered wholly different than X and XY then I'm just asking to understand what that is. Otherwise there doesn't appear to be a reason to study it.

I’m not talking about inventing a stool. I am talking about taking a three legged stool that already exists and giving it to someone who has never seen or used a 3 legged stool. Again, I don’t know why this three drug cocktail got traction, and I don’t treat Covid at all, but if you want to convince the people who are prescribing it to stop, it would be a good idea to actually study the combination. The converse also obviously should apply, i.e. if you want to prescribe the cocktail, you should come up with a study showing that it works

ETA There was a study proposal out of New Zealand I believe that had some basic science on zinc’s role and wanted to do a clinical trial, but I haven’t seen anything on it lately. Probably because they actually had a plan to get the virus under control and don’t have any new patients 

Edited by Sawbonz

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5 hours ago, wildcat09 said:

Of course the one prominent Republican politician who gets it and isn’t completely fucking fine is their only black guy that anyone knows about.

God hates America. Absolutely hates 

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Wasn’t there some concern about a bad drug interaction using HCQ and azithromycin together?

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3 minutes ago, Bama Chick said:

Wasn’t there some concern about a bad drug interaction using HCQ and azithromycin together?

It involves an interaction between HCQ, Z-Pak, and stool.  Deadly.

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5 minutes ago, Bama Chick said:

Wasn’t there some concern about a bad drug interaction using HCQ and azithromycin together?

Yes, CV safety. There's a section titled "Risks‐Benefits of Combining the 2 Drugs" in the article I linked above.

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16 hours ago, Anastasis said:

I wouldn’t say discredited. It’s just an observational study with all the known limitations. But it is a few weeks old and has been discussed. And it’s not like the bottom line is not stated right in the quoted section of the conclusion. Levels of evidence. How do they work? 

They did exclude 267 patients without outcomes (death or discharge) during the time period, which was about 9% of the total patient group during the study’s time period. There were other smaller groups of patients excluded, as well. 

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Posted (edited)
2 hours ago, SimonBolivar said:

 

2015? Shit if I came from November of 2016 I'd shrug and say "of course"

Edited by Wanker Bob

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I wonder if Herman Cain's afterlife is Rick Perry's family ranch? What was it called again?

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1 hour ago, kopp0e said:

RIP Mr. Cain...

 

This tweet didn’t age well.

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All this talk about stools.  Are you saying that if we want to study the efficacy of a stool, we need a valid.....stool sample?

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mpu


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