It is "common knowledge" in medicine that HCQ doesn't work. I don't think that the evidence supports this belief in _one particular case_--when treatment with a clinical dose of HCQ begins within 72 hours of symptom onset.
There have been various trials of HCQ--many showing no benefit--in hospitalized patients when treatment is started late. This is mostly uncontroversial among HCQ adherents, because the working hypothesis is that HCQ is an antiviral which is best given before viral load achieves a maximum, which, in mild cases of healthy people, has been found to be close to 72 hours after symptom onset. We would expect that in high risk people, treatment should likewise be started within 72 hours for best prognosis, even if the viral load doesn't reach a maximum until later than 72 hours because likely the viral load in high risk people is much higher than in the healthy group and viral replication is best stopped early.
What is the evidence for the 72 hour optimal treatment window? Not a lot, because the working hypothesis has barely been tested. Accinelli found that there were no fatalities in his treatment population when treatment began within 72 hours of symptom onset in his retrospective study of 1265 patients treated with HCQ.
"Hydroxychloroquine / azithromycin in COVID-19: The association between time to treatment and case fatality rate"
"Results
A total of 1265 COVID-19 patients with an average age of 44.5 years were studied. Women represented 50.1% of patients, with an overall 5.9 symptom days, SpO2 97%, temperature of 37.3 °C, 41% with at least one comorbidity and 96.1% one symptom or sign. No patient treated within the first 72 h of illness died."
Accinelli suffers from studying a young population. There was a fair amount of control of the patient population, which we see in the methods. Accinelli is promising--that is the best that we can say.
You can find many "early treatment" studies at c19hcq.com/ . Unfortunately, in these studies, the median time to treatment often begins after the 72 hour treatment window post symptom onset (PSO). When you look at the median time to treatment in these studies, the further that the median value is from 72 hours, the less benefit from HCQ we see.
So the 72 hour PSO covid treatment hypothesis (which should really be attributed to one of the authors in the Accinelli study) suffers from a lack of adequate testing. (This hypothesis would apply to all proposed antivirals against covid.) However, Accinelli's data is promising and suggests that the 72H-PSO hypothesis should be tested by RCTs with various antivirals, including remdesivir, HCQ, molnupravir, ivermectin, paxlovid, the various MAB treatments, etc.
Thank you for saying exactly what I have been thinking! Unfortunately, when you quote the evidence you often get the smackdown from those who don't want to hear it. I'm exhausted from dealing with this and looking forward to reading posts that are actually informed and intelligent. The best part of the pandemic has been finding you and Zubin and your candid posts and podcasts.
"A significant problem of our current healthcare system, one which will affect how we deal with monkeypox, is manifested by an arrogantly derogatory comment made here by a doctor about the largely overworked, undertrained, underappreciated, underpaid people who are "lower" in the medical hierarchy than she is, especially those who she calls “'technicians' with possible high school diplomas." My own experience both as a patient and (a long time ago) a primary care medic is that, by and large, the "lower downs" are better than the "higher ups." In my own health care/insurance system, I have given up trying to find a good primary care doctor and, instead, have a truly excellent Physicians Assistant as my medical provider. In addition, all the techs who support her are also excellent. They all do the three things most primary care doctors no longer do: 1/ listen 2/ act as my advocate 3/ don't pretend to know more than they do. The arrogant attitude on the part of doctors was what allowed the medical profession to be taken over by insurance companies and non-medical corporations, whose only concern, highly paid public relations to the contrary notwithstanding, is profit, pure and simple profit."
I would love to see data on how many people are hurt by “screening” with blood tests. The “d-dimer” on almost every patient, how many clinically significant Pulm Emboli do we find, vs cancer from radiation, renal failure from contrast, other non clinically significant findings on unnecessary scans that cause more stress, anxiety and cost
What about the troponin, how many MI do we really find, vs unnecessary tests, cath’s consult and the negative of those. These tests are not developed and studied the way they are used and weaponized against patients and health care providers
(1) In people who are supplying evidence: That the experiments were performed in good-faith, that ingredients were not manipulated, that the data was not massaged, that the study is representative of real-world results by well-meaning people, and not an accidental or manipulated outcome that was published because it's what people want to see, but does not reflect real-life outcomes.
(2) In people who decide which research gets done, who gets funded, and which evidence is or is not published.
We currently do not have a society that meets these conditions. We just don't. So we can forget about "evidence-based medicine" until we have a revolution in ethics. Once we have a revolution in ethics, any new "evidence-based medicine" must endure a lot more probing to be trusted.
The scientists who work for Eli Lilly who invented prozac came forward years ago and admitted they confabulated the serotonin hypothesis, and somehow it got rapidly covered up. I'm glad this is being uncovered again.
Good to hear your willingness to have a diversity of views on this issue. They have indeed had problems over the past 2+ years at this point. Some of it is finally coming back but many people who were using established medicinal practices and talking about policy who were attacked for it 2 years ago aren't going to get an apology any time soon.
Funny that you bring up "evidenced based medicine". A part of a comment I erased in reply to Dr Mandrola, was bringing this "misnomer" into focus. If you looked deeply at much ALLEGED "evidenced based" guidelines, you would find some of the same fraud and corruption you LIVED THROUGH with Covid and you never were the wiser until now (if you dig into much of the guidelines, you will be wiser, and disheartened.) Look at Framingham study. That took us far away from lifestyle change for DM and directly toward meds. ADA received 1 million from novartis the year they promoted meds for DM. Also look at FDA approval of sweeteners. It all leads back to one govt study where the conclusion doesn't match the data within. The FDA director went to work for, you guessed it, the sweetener company after leaving the FDA.
How about a discussion with real doctors such as Pierre Kory, Peter McCullough, Ryan Cole, Jay Battacharya, Martin Kuldorff ,Tess Lawrie, Harvey Risch, Bhakdi, data analyst Joel Smalley, legal expert Aaron Siri.
Sadly, Vinay was a fence-sitter. Easier to be bold when the facade is crumbling. Dr Birx admitted this week they knew in January 2021 the vaccine was leaky but continued on with mandates and empty promises...
...based on hope, according to Dr. Birx. Only after Rep. Jim Jordan pressed her with questions.
Science was uninvolved in their decision-making. No long term animal studies of carcinogenicity, teratogenicity, etc. No consideration of harms which pharma had seen in studies of other mRNA vaccines.
The whole thing looks like a military operation. Considering that Operation Warped Greed was run by ex-military, according to David Martin, this is unsurprising.
What we do know on the medicine side of things is that there is really no evidence to support the use of cloth or surgical masks to prevent spread of aerosolized viral particles. There wasn’t any before COVID and there isn’t now.
Even when N95 masks are used in the hospital setting for “airborne” infectious agent exposure precautions proper fitting is required, no facial hair can be present because fit is compromised, the masks are single use and we use negative pressure airflow systems in the patient’s rooms to filter the air before it is expelled from the building. The idea that we could use N95 masks to prevent COVID spread was always folly.
No, their training is inadequate. Even in physics, studies surrounding mask dynamics are in their infancy. The data is lacking, so the science is lacking. I can't conclusively say that N95 masks don't work. They _may_ work for a time when properly fitted, which requires training. Studies would be required to be able to plot the carrying capacity curve for N95 masks with respect to viruses. (N95 masks tend to become saturated over time.)
The following article will give you some perspective on the status of the physics of mask dynamics. Note that it was published in Jan. 2022 in Nature. Groundbreaking. Super cool. Great methodology. A high quality article, unlike a lot of the articles in Physics of Fluids. And just the beginning of research in the field and very recent.
That was the case for absorbent fabrics. We don't know about the case for non-absorbent fabrics. This article concluded that absorbent fabrics increase evaporation rate a great deal. This means that the time of a droplet's existence in a mask is very short. Eventually all that is left is a residue.
We don't yet know what happens to the residue. It could be that it gets worked on by friction from air jets and the mask, which would tend to cause it to disintegrate. (That's my expectation.) Will free virus be the result of the hypothetical disintegration? Maybe. (I expect that some considerable fraction of the residue will result in free virus aerosol.)
Masks may actually _increase_ free virus aerosol. Consider that droplets >100 microns simply fall to the floor in the unmasked case. In the masked case, they are caught and possibly the viruses in the >100 micron droplets are eventually released as free virus aerosol.
So, there is a lot of physics research on masks yet to be done.
And if physics research into masks is in its infancy, then the science is unknown and public mask mandates are based on considerations other than science. Maybe hope and fear.
If data leads you to conclude that COVID vaccines are neither safe enough nor effective enough for the benefits to outweigh the risks, will you share that information, or will you hold back for fear of being disciplined?
It is "common knowledge" in medicine that HCQ doesn't work. I don't think that the evidence supports this belief in _one particular case_--when treatment with a clinical dose of HCQ begins within 72 hours of symptom onset.
There have been various trials of HCQ--many showing no benefit--in hospitalized patients when treatment is started late. This is mostly uncontroversial among HCQ adherents, because the working hypothesis is that HCQ is an antiviral which is best given before viral load achieves a maximum, which, in mild cases of healthy people, has been found to be close to 72 hours after symptom onset. We would expect that in high risk people, treatment should likewise be started within 72 hours for best prognosis, even if the viral load doesn't reach a maximum until later than 72 hours because likely the viral load in high risk people is much higher than in the healthy group and viral replication is best stopped early.
What is the evidence for the 72 hour optimal treatment window? Not a lot, because the working hypothesis has barely been tested. Accinelli found that there were no fatalities in his treatment population when treatment began within 72 hours of symptom onset in his retrospective study of 1265 patients treated with HCQ.
"Hydroxychloroquine / azithromycin in COVID-19: The association between time to treatment and case fatality rate"
"Results
A total of 1265 COVID-19 patients with an average age of 44.5 years were studied. Women represented 50.1% of patients, with an overall 5.9 symptom days, SpO2 97%, temperature of 37.3 °C, 41% with at least one comorbidity and 96.1% one symptom or sign. No patient treated within the first 72 h of illness died."
https://www.sciencedirect.com/science/article/pii/S1477893921002040
Accinelli suffers from studying a young population. There was a fair amount of control of the patient population, which we see in the methods. Accinelli is promising--that is the best that we can say.
You can find many "early treatment" studies at c19hcq.com/ . Unfortunately, in these studies, the median time to treatment often begins after the 72 hour treatment window post symptom onset (PSO). When you look at the median time to treatment in these studies, the further that the median value is from 72 hours, the less benefit from HCQ we see.
So the 72 hour PSO covid treatment hypothesis (which should really be attributed to one of the authors in the Accinelli study) suffers from a lack of adequate testing. (This hypothesis would apply to all proposed antivirals against covid.) However, Accinelli's data is promising and suggests that the 72H-PSO hypothesis should be tested by RCTs with various antivirals, including remdesivir, HCQ, molnupravir, ivermectin, paxlovid, the various MAB treatments, etc.
Thank you for saying exactly what I have been thinking! Unfortunately, when you quote the evidence you often get the smackdown from those who don't want to hear it. I'm exhausted from dealing with this and looking forward to reading posts that are actually informed and intelligent. The best part of the pandemic has been finding you and Zubin and your candid posts and podcasts.
Thanks for being a catalyst for change!
FROM THE NYTIMES...
"A significant problem of our current healthcare system, one which will affect how we deal with monkeypox, is manifested by an arrogantly derogatory comment made here by a doctor about the largely overworked, undertrained, underappreciated, underpaid people who are "lower" in the medical hierarchy than she is, especially those who she calls “'technicians' with possible high school diplomas." My own experience both as a patient and (a long time ago) a primary care medic is that, by and large, the "lower downs" are better than the "higher ups." In my own health care/insurance system, I have given up trying to find a good primary care doctor and, instead, have a truly excellent Physicians Assistant as my medical provider. In addition, all the techs who support her are also excellent. They all do the three things most primary care doctors no longer do: 1/ listen 2/ act as my advocate 3/ don't pretend to know more than they do. The arrogant attitude on the part of doctors was what allowed the medical profession to be taken over by insurance companies and non-medical corporations, whose only concern, highly paid public relations to the contrary notwithstanding, is profit, pure and simple profit."
Like cream, best rise to the top.
AND my bulb lights up: hope, espoir
I would love to see data on how many people are hurt by “screening” with blood tests. The “d-dimer” on almost every patient, how many clinically significant Pulm Emboli do we find, vs cancer from radiation, renal failure from contrast, other non clinically significant findings on unnecessary scans that cause more stress, anxiety and cost
What about the troponin, how many MI do we really find, vs unnecessary tests, cath’s consult and the negative of those. These tests are not developed and studied the way they are used and weaponized against patients and health care providers
"Evidence-based medicine" requires absolute trust:
(1) In people who are supplying evidence: That the experiments were performed in good-faith, that ingredients were not manipulated, that the data was not massaged, that the study is representative of real-world results by well-meaning people, and not an accidental or manipulated outcome that was published because it's what people want to see, but does not reflect real-life outcomes.
(2) In people who decide which research gets done, who gets funded, and which evidence is or is not published.
We currently do not have a society that meets these conditions. We just don't. So we can forget about "evidence-based medicine" until we have a revolution in ethics. Once we have a revolution in ethics, any new "evidence-based medicine" must endure a lot more probing to be trusted.
The scientists who work for Eli Lilly who invented prozac came forward years ago and admitted they confabulated the serotonin hypothesis, and somehow it got rapidly covered up. I'm glad this is being uncovered again.
Good to hear your willingness to have a diversity of views on this issue. They have indeed had problems over the past 2+ years at this point. Some of it is finally coming back but many people who were using established medicinal practices and talking about policy who were attacked for it 2 years ago aren't going to get an apology any time soon.
No doubt, your Substack will be essential reading well into the future.
Funny that you bring up "evidenced based medicine". A part of a comment I erased in reply to Dr Mandrola, was bringing this "misnomer" into focus. If you looked deeply at much ALLEGED "evidenced based" guidelines, you would find some of the same fraud and corruption you LIVED THROUGH with Covid and you never were the wiser until now (if you dig into much of the guidelines, you will be wiser, and disheartened.) Look at Framingham study. That took us far away from lifestyle change for DM and directly toward meds. ADA received 1 million from novartis the year they promoted meds for DM. Also look at FDA approval of sweeteners. It all leads back to one govt study where the conclusion doesn't match the data within. The FDA director went to work for, you guessed it, the sweetener company after leaving the FDA.
It continues to be mind-blowing to witness continued propaganda- I just read this MASK article on Bill Gates GAVI website.
It's 100% about CONTROLLING people- all of it
https://www.gavi.org/vaccineswork/mask-mandates-will-we-only-act-public-health-advice-if-someone-makes-us
Obamacare gave us hospital-administrator controlled and pharma controlled medicine, where before it was health insurance that controlled medicine.
We were better off when health insurance only provided catastrophic coverage.
How about a discussion with real doctors such as Pierre Kory, Peter McCullough, Ryan Cole, Jay Battacharya, Martin Kuldorff ,Tess Lawrie, Harvey Risch, Bhakdi, data analyst Joel Smalley, legal expert Aaron Siri.
Sadly, Vinay was a fence-sitter. Easier to be bold when the facade is crumbling. Dr Birx admitted this week they knew in January 2021 the vaccine was leaky but continued on with mandates and empty promises...
...based on hope, according to Dr. Birx. Only after Rep. Jim Jordan pressed her with questions.
Science was uninvolved in their decision-making. No long term animal studies of carcinogenicity, teratogenicity, etc. No consideration of harms which pharma had seen in studies of other mRNA vaccines.
The whole thing looks like a military operation. Considering that Operation Warped Greed was run by ex-military, according to David Martin, this is unsurprising.
What makes those specific doctors “real”?
Perhaps that they used critical thinking and took huge risks to help others.
Maybe with a physicist to discuss masks, too? There must be one somewhere who would be willing to discuss mask interventions.
Or an industrial hygienist?
What we do know on the medicine side of things is that there is really no evidence to support the use of cloth or surgical masks to prevent spread of aerosolized viral particles. There wasn’t any before COVID and there isn’t now.
Even when N95 masks are used in the hospital setting for “airborne” infectious agent exposure precautions proper fitting is required, no facial hair can be present because fit is compromised, the masks are single use and we use negative pressure airflow systems in the patient’s rooms to filter the air before it is expelled from the building. The idea that we could use N95 masks to prevent COVID spread was always folly.
No, their training is inadequate. Even in physics, studies surrounding mask dynamics are in their infancy. The data is lacking, so the science is lacking. I can't conclusively say that N95 masks don't work. They _may_ work for a time when properly fitted, which requires training. Studies would be required to be able to plot the carrying capacity curve for N95 masks with respect to viruses. (N95 masks tend to become saturated over time.)
The following article will give you some perspective on the status of the physics of mask dynamics. Note that it was published in Jan. 2022 in Nature. Groundbreaking. Super cool. Great methodology. A high quality article, unlike a lot of the articles in Physics of Fluids. And just the beginning of research in the field and very recent.
"Droplet evaporation on porous fabric materials"
https://www.nature.com/articles/s41598-022-04877-w
That was the case for absorbent fabrics. We don't know about the case for non-absorbent fabrics. This article concluded that absorbent fabrics increase evaporation rate a great deal. This means that the time of a droplet's existence in a mask is very short. Eventually all that is left is a residue.
We don't yet know what happens to the residue. It could be that it gets worked on by friction from air jets and the mask, which would tend to cause it to disintegrate. (That's my expectation.) Will free virus be the result of the hypothetical disintegration? Maybe. (I expect that some considerable fraction of the residue will result in free virus aerosol.)
Masks may actually _increase_ free virus aerosol. Consider that droplets >100 microns simply fall to the floor in the unmasked case. In the masked case, they are caught and possibly the viruses in the >100 micron droplets are eventually released as free virus aerosol.
So, there is a lot of physics research on masks yet to be done.
And if physics research into masks is in its infancy, then the science is unknown and public mask mandates are based on considerations other than science. Maybe hope and fear.
If data leads you to conclude that COVID vaccines are neither safe enough nor effective enough for the benefits to outweigh the risks, will you share that information, or will you hold back for fear of being disciplined?
Prasad is delving into philosophy of science and he needs to do more reading of what philosophers of medicine say about RCTs.
https://plato.stanford.edu/entries/medicine/#RandContTriaEvidBaseMedi
Exactely. That's an intense 'article' and important. RCT's are not the sole acceptable evidence.
I would love for Dr. Prasad to delve into this topic more, including this analysis in the Cochrane database:
https://www.cochrane.org/MR000034/METHOD_comparing-effect-estimates-of-randomized-controlled-trials-and-observational-studies.
It seems to me that using observational trial results that have good design might be an important resource during a pandemic.