Here are a list of topics people may want to hear about from the docs. Will the readers please upvote this comment if you see a question that intrigues you?
What is the rationale for withholding antivirals like HCQ and IVM from ambulatory covid patients and instead giving them to hospitalized patients? Will antivirals help prevent progression and is preventing progression important?
Do they personally know any primary care physician who have tried giving HCQ or IVM early (2-4 days post symptom onset) for covid and found that they don't work? (The Black Swan test)
What did the docs think about all the "concern" over the "danger" of HCQ and IVM for treating mild covid? How much of the scare was due to pharma's marketing subcontractors and perhaps to physician influencers paid by pharma?
Hypothetically, let's assume that mRNA vaccines can cause injuries via spike proteins. What injuries might the spike proteins (or immune reactions to them) cause and how might those injuries be detected? (Let's cast a wide net here--the CDC's list is a starting point.)
How is it that all of the western public health authorities (except Sweden) followed pretty much the same absurd, superstitious script for the first 18 months of the pandemic (lockdowns, quarantines of asymptomatic people, travel quarantines, social distancing, masking children, censoring dissenting doctors), while the rest of the world (mostly) were more rational?
Are the docs at all concerned about all the censorship of dissenting docs that we have seen on social media and what have they done to fight the censorship? Or have they decided that science is no longer about two sides of a scientific controversy having a conversation about data and methods? (The second is a rhetorical question meant to clarify.)
"What is the rationale for withholding antivirals like HCQ and IVM from ambulatory covid patients.." Recent excellent paper in NEJM (randomized controlled trial) here on ambulatory use of IVM https://www.nejm.org/doi/full/10.1056/NEJMoa2201662
How about if I show my thought process in analyzing this paper so that you can determine how solid my analysis is?
This paper is about treating ambulatory covid patients with various treatments and comparing results. Researchers are separated from patient selection, so they can't bias the patient selection. The statisticians are involved in randomization of patients, but patient characteristics are hidden from them.
Now let's consider what covid is. Covid is caused by a viral infection of the nasopharynx which goes viremic before symptom onset. Covid pathology is multimodal, but the primary damage is to the microvascular endothelium, with clotting and inflammation resulting from the damage to the endothelium. In some patients, there is failure to reduce inflammation after the immune system has cleared the virus, resulting in immune attack of the infected tissues. Covid is a progressive disease where progression occurs due to inflammation and hypoxia. Death can occur from covid due to ARDS, systemic organ failure, clotting in coronary arteries--either embolii or thrombii, pulmonary embolism, or stroke. Max viral load occurs at three days in mild covid cases and virus is cleared by eight days, per Didier Raoult, who performed cell culturing as confirmation. Raoult's result is confirmed by two other lines of evidence--a Hopkins study showed a floor in false negative PCR test results at three days post symptom onset, with negative results increasing in either direction along a time curve. And Accinelli found that covid mortality was associated with treatment of an antiviral (HCQ in his study) when treatment was initiated after 72 hours from symptom onset, but no mortality occurred within the 72 hour window.
Now to the paper. Treatment with IVM is controversial, so we shall have to look at the data.
The dosing with IVM looks adequate, tho a bit on the low side. The primary endpoint is fairly squishy and this is likely due to the trial being underpowered to consider hospitalization or mortality as primary endpoints. ER visits had to be added in order to test significance. There was one death in the IVM arm and none in placebo, but this isn't significant for trial results.
Couriers delivered treatment to patients. The mean time of treatment initiation from symptom onset was 4.7 days. Almost assuredly, no patients received treatment within the 72 hour window post symptom onset. In terms of significance affecting trial results, this is a mountain. Giving antivirals for covid after the treatment window looks to be consistently ineffective. In the best case, for mild covid patients, the immune response is winning starting at 72 hours, so antivirals will have minimal impact. In the worst case, max viral load isn't reached until later, with exponential increase in damage occurring each day, resulting in progression, hospitalization, and possibly death. Delaying antiviral treatment does these weaker patients no good, which is what Accinelli found.
So the glaring weakness of the Boulware paper that you referenced is delayed time to treatment from symptom onset. Imo, it should be retracted.
This paper shows that researcher bias can be inserted thru improper trial design in RCTs. Isn't Boulware paid by Gilead?
Academia and allopathic medicine have screwed up this pandemic in so many ways, which has ruined their reputations for many people--probably between ten and twenty percent of the country.
The massive death toll (an extra 137,000 deaths!) in the US working age population in 2021 due to unscientific and absurd pandemic responses is being noticed by the low information population. The word is getting out about the lack of benefit for kids from covid vaccines, resulting in millions of doses being trashed.
A lot of people will now vet their doctors on their views about vaccines. And people writing the history of medicine will notice that HCQ shows benefit when given within 72 hours of symptom onset and that it was smeared by pharma and their allopathic lackeys. And the historians will excoriate allopathic medicine for the failure to oppose the smear and failure to treat with inexpensive repurposed drugs, resulting in hundreds of thousands of premature deaths. And the reckoning may come sooner. There are people now gathering attorneys to figure out effective ways to sue doctors for failure to treat. Primary care doctors have the biggest liability.
If the aim of this blog is to show how to discuss respectfully and scientifically, then perhaps it would be good to get a real rebel to join the authors--say, Clare Craig of the UK's HART group, Peter McCullough, or Robert Malone.
Malcolm Kendrick's blog is an example of how to get commenters involved and adding value to the discussion.
Sort of an aside, but very glad to see Yuri Besmenov (KGB defector) commenting here. If you haven't seen the 1984 interview, "The Four Stages of Ideological Subversion" on youtube, take a look. Very telling.
"This virus was so terrible in 2020 because we had no immunity."
Really? As I recall, the mortality was an exponential curve by age, with most mortality being in those 80+ y.o. So innate and mucosal immunity must have offered some sort of protection.
The UK Challenge Trials proved that nearly half of the mostly younger volunteers did not get infected despite direct placement of the virus in their noses. See https://www.nature.com/articles/s41591-022-01780-9. Other had a mild infection some asymptotic but shedding active virus.
Physics tends to undermine the theory that catching droplets will prevent viral aerosolization. N-95 masks _may_ offer some protection, but the carrying capacity efficacy against viruses hasn't been studied, to my knowledge. The study of masking in physics is still in its infancy and masking, of course, is a physical intervention, so an industrial painter who wears a mask at work might have as valuable a perspective on masks as a physician.
There was a valuable study in Jan. 2022 in Nature on absorbent fabrics, wicking, and evaporation--that is a solid beginning.
I have yet to see anything valuable from the cdc on masking to prevent viral transmission.
https://likacct1.substack.com/p/jordan-peterson?r=1nc1u1&s=w&utm_campaign=post&utm_medium=email
@VinayPrasadMD
@AdlamCifuMD
@AndyDavisMD
Here are a list of topics people may want to hear about from the docs. Will the readers please upvote this comment if you see a question that intrigues you?
What is the rationale for withholding antivirals like HCQ and IVM from ambulatory covid patients and instead giving them to hospitalized patients? Will antivirals help prevent progression and is preventing progression important?
Do they personally know any primary care physician who have tried giving HCQ or IVM early (2-4 days post symptom onset) for covid and found that they don't work? (The Black Swan test)
What did the docs think about all the "concern" over the "danger" of HCQ and IVM for treating mild covid? How much of the scare was due to pharma's marketing subcontractors and perhaps to physician influencers paid by pharma?
Hypothetically, let's assume that mRNA vaccines can cause injuries via spike proteins. What injuries might the spike proteins (or immune reactions to them) cause and how might those injuries be detected? (Let's cast a wide net here--the CDC's list is a starting point.)
How is it that all of the western public health authorities (except Sweden) followed pretty much the same absurd, superstitious script for the first 18 months of the pandemic (lockdowns, quarantines of asymptomatic people, travel quarantines, social distancing, masking children, censoring dissenting doctors), while the rest of the world (mostly) were more rational?
Are the docs at all concerned about all the censorship of dissenting docs that we have seen on social media and what have they done to fight the censorship? Or have they decided that science is no longer about two sides of a scientific controversy having a conversation about data and methods? (The second is a rhetorical question meant to clarify.)
"What is the rationale for withholding antivirals like HCQ and IVM from ambulatory covid patients.." Recent excellent paper in NEJM (randomized controlled trial) here on ambulatory use of IVM https://www.nejm.org/doi/full/10.1056/NEJMoa2201662
Malone also sees this study as designed to fail.
https://rwmalonemd.substack.com/p/well-being-cardiovascular-damage/comments
How about if I show my thought process in analyzing this paper so that you can determine how solid my analysis is?
This paper is about treating ambulatory covid patients with various treatments and comparing results. Researchers are separated from patient selection, so they can't bias the patient selection. The statisticians are involved in randomization of patients, but patient characteristics are hidden from them.
Now let's consider what covid is. Covid is caused by a viral infection of the nasopharynx which goes viremic before symptom onset. Covid pathology is multimodal, but the primary damage is to the microvascular endothelium, with clotting and inflammation resulting from the damage to the endothelium. In some patients, there is failure to reduce inflammation after the immune system has cleared the virus, resulting in immune attack of the infected tissues. Covid is a progressive disease where progression occurs due to inflammation and hypoxia. Death can occur from covid due to ARDS, systemic organ failure, clotting in coronary arteries--either embolii or thrombii, pulmonary embolism, or stroke. Max viral load occurs at three days in mild covid cases and virus is cleared by eight days, per Didier Raoult, who performed cell culturing as confirmation. Raoult's result is confirmed by two other lines of evidence--a Hopkins study showed a floor in false negative PCR test results at three days post symptom onset, with negative results increasing in either direction along a time curve. And Accinelli found that covid mortality was associated with treatment of an antiviral (HCQ in his study) when treatment was initiated after 72 hours from symptom onset, but no mortality occurred within the 72 hour window.
Now to the paper. Treatment with IVM is controversial, so we shall have to look at the data.
The dosing with IVM looks adequate, tho a bit on the low side. The primary endpoint is fairly squishy and this is likely due to the trial being underpowered to consider hospitalization or mortality as primary endpoints. ER visits had to be added in order to test significance. There was one death in the IVM arm and none in placebo, but this isn't significant for trial results.
Couriers delivered treatment to patients. The mean time of treatment initiation from symptom onset was 4.7 days. Almost assuredly, no patients received treatment within the 72 hour window post symptom onset. In terms of significance affecting trial results, this is a mountain. Giving antivirals for covid after the treatment window looks to be consistently ineffective. In the best case, for mild covid patients, the immune response is winning starting at 72 hours, so antivirals will have minimal impact. In the worst case, max viral load isn't reached until later, with exponential increase in damage occurring each day, resulting in progression, hospitalization, and possibly death. Delaying antiviral treatment does these weaker patients no good, which is what Accinelli found.
So the glaring weakness of the Boulware paper that you referenced is delayed time to treatment from symptom onset. Imo, it should be retracted.
This paper shows that researcher bias can be inserted thru improper trial design in RCTs. Isn't Boulware paid by Gilead?
Raoult: https://link.springer.com/article/10.1007/s10096-020-03913-9
Hopkins: https://www.acpjournals.org/doi/10.7326/M20-1495
Accinelli: https://www.sciencedirect.com/science/article/pii/S1477893921002040
Thanks, Vinay.
Watching Dr. Prasad on video, I'd have thought that he wears masks. Dr. Davis also comes across as acidotic, but in a nice way. haha
I enjoyed reading Vinay Prasad’s answers.
Academia and allopathic medicine have screwed up this pandemic in so many ways, which has ruined their reputations for many people--probably between ten and twenty percent of the country.
The massive death toll (an extra 137,000 deaths!) in the US working age population in 2021 due to unscientific and absurd pandemic responses is being noticed by the low information population. The word is getting out about the lack of benefit for kids from covid vaccines, resulting in millions of doses being trashed.
A lot of people will now vet their doctors on their views about vaccines. And people writing the history of medicine will notice that HCQ shows benefit when given within 72 hours of symptom onset and that it was smeared by pharma and their allopathic lackeys. And the historians will excoriate allopathic medicine for the failure to oppose the smear and failure to treat with inexpensive repurposed drugs, resulting in hundreds of thousands of premature deaths. And the reckoning may come sooner. There are people now gathering attorneys to figure out effective ways to sue doctors for failure to treat. Primary care doctors have the biggest liability.
Please ask docs who are UNvaxed, aware of vax injuries.
If the aim of this blog is to show how to discuss respectfully and scientifically, then perhaps it would be good to get a real rebel to join the authors--say, Clare Craig of the UK's HART group, Peter McCullough, or Robert Malone.
Malcolm Kendrick's blog is an example of how to get commenters involved and adding value to the discussion.
Thank Dr Prasad for your sensible and realistic view of Covid.
You have the exact brain and philosophy that I have lived my life now 71. My father said “nobody promised you tomorrow so enjoy today”!
Sort of an aside, but very glad to see Yuri Besmenov (KGB defector) commenting here. If you haven't seen the 1984 interview, "The Four Stages of Ideological Subversion" on youtube, take a look. Very telling.
Vinay! No good movies? Go see Nope - it’s amazing!
Here's Dr. Prasad's take on protecting yourself.
"For most that means lose weight, and get vaccinated (assuming you haven’t had COVID already)."
Two questions:
First, is vitamin D supplementation important and if so, what amount would you recommend? What 25OHD level would you aim for?
Second, are you planning to take boosters ad nauseam, or only until you catch covid?
"This virus was so terrible in 2020 because we had no immunity."
Really? As I recall, the mortality was an exponential curve by age, with most mortality being in those 80+ y.o. So innate and mucosal immunity must have offered some sort of protection.
The UK Challenge Trials proved that nearly half of the mostly younger volunteers did not get infected despite direct placement of the virus in their noses. See https://www.nature.com/articles/s41591-022-01780-9. Other had a mild infection some asymptotic but shedding active virus.
Physicist here.
"but mask when doing so with a good KN95"
Physics tends to undermine the theory that catching droplets will prevent viral aerosolization. N-95 masks _may_ offer some protection, but the carrying capacity efficacy against viruses hasn't been studied, to my knowledge. The study of masking in physics is still in its infancy and masking, of course, is a physical intervention, so an industrial painter who wears a mask at work might have as valuable a perspective on masks as a physician.
There was a valuable study in Jan. 2022 in Nature on absorbent fabrics, wicking, and evaporation--that is a solid beginning.
I have yet to see anything valuable from the cdc on masking to prevent viral transmission.
Vinay Prasad is so right! Thank you.