[conspire] (forw) Not quite getting it

[Rich Kulawiec]

On Sun, Mar 22, 2020 at 02:28:51PM -0700, Texx wrote:
> There is talk of cloroquin and an HIV med being used.

There is talk of it because someone with an understanding of
medical/scientific issues inferior to the average fifth-grader *but*
with a very large Twitter following babbled about it.

Let's just put that to rest now, shall we?   

The apparent reason for this "talk" is a study which may be referenced
as: "Gautret et al. (2020) Hydroxychloroquine and azithromycin as
a treatment of COVID-19: results of an open non-randomized clinical trial".

Here is what Dr. Ryan Marino (emergency medicine/toxicology) had to say
about that study (this is my transcription and may have typos -- link to the
original PNG follows):

	"While this sounds promising on the surface, the study is
	seriously methodologically flawed and so limited that it is not
	able to support any conclusions, let alone the one conclusion
	that has made it all the way to White House tweets. This was
	a nonrandomized, unblinded trial, and in the treatment group
	multiple patients were removed from the final data set who a)
	ended up in the ICU b) had to stop treatment (likely due to
	toxicity) and c) died.	The primary outcome reported was not in
	fact "cure" or any clinically significant outcome but actually
	reduced detection of virus, with very concerning confounders
	even in that regard that were present prior to the intervention.

	TL;DR: this study does not actually support any treatment
	intervention for COVID19 and is very flawed and limited.
	Further study may be warranted, but practice implementation
	should not be recommended."

He (Dr. Marino) goes on to express his concern with the toxicity of HCQ and
notes that there have already been reports outside the US of fatal poisonings
from HCQ plus arithromycin or other quinolones being used in combination
to treat/prevent COVID19.

If you aren't a scientist, this might be a bit opaque, so let me translate
the phrase "nonrandomized, unblinded" as: "we rigged the game" and clauses
(a) (b) and (c) above as: "and yet we still lost very badly".  I don't
say this to cast aspersions on the work, lots of studies are done this way
because they're done under duress in desperate attempts to come up with
something, anything.  While respecting such efforts and encouraging them --
this is one way we make progress and failure is a necessary part of
that -- we still have to candidly assess the methodology and outcomes.

Here's a link the to the PNG, which I recommend reading:

	Dr. Ryan Marino - emergency medication, toxicoloy - debunks chloroquine claims [PNG]
	http://www.firemountain.net/pix/chloroquine-refute-ryan-marino.png

Let me also quote Michael G. Abesamis -- medical toxicologist, addiction
specialist, emergency medicine physician:

	"Less than 2 days after the press conference/tweet went out,
	we had cases of hydroxychloroquine toxcity at the poison control
	center.  Less than 96 hours after, we now have shortages of the
	drugs in some states."

Those shortages are a problem, you see, because some people take
hydroxychloroquine on a regular basis for unrelated reasons.  Thus
ill-informed stockpiling of it by other people is depriving them 
of their medication.  And of course the last thing the poison control
center or any other medical facility needs right now is more patients.

TL;DR, my version: don't take medical advice from people who can't
understand the exponential function. [1]

Since I'm writing anyway, let me mention this:

	Covid19
	http://www.firemountain.net/covid.html

This is a page I put together, ostensibly for NANOG.  It is my attempt to
curate the most useful (North American-centric) resources and enumerate
them on a page with minimal markup, no scripting, no graphics, no nothing,
so that it will load quickly and hopefully render properly in any browser --
including text-only browsers.  Arguably I've missed my goal of covering
North America (since most of what's on that page is US-centric) so I'm
presently working on fixing that.  I haven't yet tackled making it
multilingual.  But I should.

I welcome suggested additions -- off-list, please.  I also welcome
corrections: I've tried to use authoritative medical/scientific sources
and have checked each one but I'm not infallible.  At least not this
week, ask me next week. ;)  So if some nonsense has made it past my filters,
let me know.

That page also contains a link to the COVID-19 Folding at Home project that
any of us can assist by lending out some time on our systems and to a
Coursera course on COVID-19.

Finally, a suggestion.  If you have any spare cash and if there are local
restaurants in your area that are still operating, then order some food
and have it delivered to your nearest hospital.  They *love* outside
food because at times like this it's cafeteria, cafeteria, cafeteria.
You can support what is likely to be a struggling business and you can
provide a little bright spot in the day for people who are watching
a terrible, dark, wall approaching on the horizon and are preparing
to stand directly in its path.

---rsk

[1] A favorite quote of mine for decades:

"The greatest shortcoming of the human race is man's inability to understand
the exponential function."  --- Albert A. Bartlett