Coronadoom has long been politicized; since day one, really. The best way to handle it, said political authorities, was the opposite of whatever President Trump said or hinted. That’s how Science™ works.
Let’s take the drug ivermectin (fun pun!). This page reports a slew of good results. Then we have this impassioned plea by a doc:
Spend 2 minutes and listen to this frontline doctor who testified at our hearing today about why early COVID treatment is key.
“We are tired. I can't keep doing this. I can't be traumatized by caring for patients when I know they could have been saved with early treatment." pic.twitter.com/mFrYdr3Sq4
— Senator Ron Johnson (@SenRonJohnson) December 9, 2020
The plea itself, as heartfelt and perhaps even true as it is, is not the point. I have no idea about this drug’s efficacy or safety. For all I know, everybody that takes it turns into a critical race theorist.
What is curious are the responses to the Senator. Most thought there must be some political angle to it all, and were ready to dismiss utterly or embrace passionately a drug five minutes before they had never even heard of.
I mention ivermectin before hydroxychloroquine (HCQ), because everybody knows HCQ.
For good reason. Who remembers how The Lancet and NEJM were both scammed—or were both in on the Surgisphere strip club saga? So big a scandal was it that even the progressive press was forced to cover it. I don’t recall hearing an explanation from the respective editors why they were so anxious to publish the original papers.
Even supposing HCQ does only harm, their idiotic move helped create the suspicion that something was being hidden, that HCQ worked too well.
Now we have a new statement by our medical rulers demanding they be taken seriously. Seriously? If we take these guys any more seriously, there will be no one left to take them seriously. Seriously. Anyway, it’s Why Scientific Evidence Matters in a Pandemic.
They whine “While the COVID-19 pandemic surges, the US response continues to be undermined by those promoting dangerous misinformation about unfounded therapies, attacking the credibility of public health experts, and undermining trust in medical science and the nature of evidence.”
The obvious rebuttal is: no it isn’t. Experts have done a far more efficient job than non-experts at promoting wrong and dangerous disinformation, and attacking the credibility of those not deemed sufficiently elite. Distrust in medicine and evidence rise at the same rates as the hersteria from rulers yelling “Listen to me! Or else!”
In an email, Jane Orient, who is not in the cool club, God bless her, summarized the situation well. There are, she said “two sides: 1. Let’s treat our patients as well as we can, share information, and learn as we go. 2. Let’s censor, threaten, and punish doctors on side (1), demand RCTs that meet our standard as the only kind of ‘scientific evidence,’ and deny treatment that doesn’t fit the NIH guidelines.”
(I, as regular readers know, do not agree philosophically with the “R” part of clinical trials as any kind of guarantor except possibly to reduce the chance of cheating. That’s for another day.)
Even doctors, most of whom are people, can become suspicious when the powers-that-be react first and foremost with censorship and bans.
Let’s look at HCQ in the context of the new paper “Hydroxychloroquine as Postexposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 Infection” by Ruanne V. Barnabas and others in Annals of Internal Medicine.
They begin by saying this:
Hydroxychloroquine, a chloroquine analogue, has been used safely for over 6 decades as an antimalarial and to treat autoimmune conditions, with broad activity against intracellular organisms (13). With standard dosing, chloroquine inhibits SARS-CoV-2 replication in vitro (14, 15). Observational studies in health care settings supported the use of hydroxychloroquine to prevent SARS-CoV-2 (16, 17). Hydroxychloroquine and chloroquine are widely available globally; as such, they are ideal candidates for repurposed pharmaceutical interventions to prevent SARS-CoV-2 infection because they could be rapidly disseminated for new indications, including in resource-limited settings.
So it couldn’t have been crazy or even dangerous to try HCQ, as many docs have.
The idea in this new trial was to give HCQ or vitamin C as a placebo to those in households where a household member had been “exposed” to somebody to the coronadoom within 4 days. There is, obviously, wiggle room in “exposed”. Plus, like all these trials, you have to trust people took the meds when they say they did.
The outcome is clear enough: “Participants self-collected mid-turbinate swabs daily (days 1 to 14) for SARS-CoV-2 polymerase chain reaction (PCR) testing. The primary outcome was PCR-confirmed incident SARS-CoV-2 infection among persons who were SARS-CoV-2 negative at enrollment.”
Here’s what happened:
Between March and August 2020, 671 households were randomly assigned: 337 (407 participants) to the hydroxychloroquine group and 334 (422 participants) to the control group. Retention at day 14 was 91%, and 10 724 of 11 606 (92%) expected swabs were tested. Among the 689 (89%) participants who were SARS-CoV-2 negative at baseline, there was no difference between the hydroxychloroquine and control groups in SARS-CoV-2 acquisition by day 14 (53 versus 45 events; adjusted hazard ratio, 1.10 [95% CI, 0.73 to 1.66]; P > 0.20). The frequency of participants experiencing adverse events was higher in the hydroxychloroquine group than the control group (66 [16.2%] versus 46 [10.9%], respectively; P = 0.026).
You have to divide through for the classical statistics language, in which no difference means difference, but with a non-wee p.
So, 13% in the HCQ and 11% in the placebo group tested positive.
Does that greater percentage mean HCQ causes infections sometimes? Or does that 11% mean vitamin C causes infections sometimes? Or that it causally can prevent 89% of them? Or does that 13% mean HCG causally prevents 87% of infections? Or etc.
You can see that you can’t get cause out of these numbers. Probability isn’t capable of discerning cause. You build cause into probability models, not the other way around.
The side effects of HCQ are not unknown (mostly gastric; they have a table), so there is no surprise (building the idea of cause into the data). But then we deduce there must be at least one more cause of side effects that is not HCQ, which could be vitamin C, since people in that group had side effects, too. Since this other cause or cause must exist, we don’t know the exact extent the HCQ caused side effects in that group.
The experiment only looked at PCR tests, and not at disease severity. That, and “Although we had biological confirmation of incident cases, we did not test the viability of SARS-CoV-2 via culture or subgenomic RNA analysis to assess markers of active replication and thus onward transmission.”
The authors have a generous closing: “Several reasons may explain why we found no efficacy of hydroxychloroquine for prevention of SARS-CoV-2 infection. First, the repurposed agent may have been the wrong choice of medication or used at an insufficient dose, even though pharmacokinetic modeling was used to choose the dose…”
Gist: they tried something reasonable, and found evidence HCQ isn’t that good at preventing infection. Whether it’s not good in all cases, they don’t say. Whether it prevents more severe infections, they don’t say. The side effects were not particularly bad or plentiful, as expected. And so on.
This isn’t the only paper, of course. The authors even point to some supporting HCQ. But there are other papers that do not support it. Again, there seems to be wiggle room. The evidence isn’t supportive of anybody screaming “Listen to me! Or else!”
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