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Covid19 redux


Bosco-d-gama

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45 minutes ago, BigStewMan said:

say tomorrow China says they have a vaccine and will share it -- what is the protocol from the FDA -- do we still do extensive testing?  

Could you envision China pimping a bogus vaccine? Wouldn’t surprise me anymore. 

I have a hard time believing pretty much anything they say.

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4 hours ago, Bosco-d-gama said:

Here’s a much better study defining the cardiac impact of using hydroxychlorquine on covid19 patients. The hydroxychlorquine dosages required (recommended?) for covid19 are significantly higher than other clinical applications for the drug and they can/do lead to some serious cardiac problems even in healthy hearts. So anyone with preexisting cardiac disease surely must be at greater risk for these side effects.

 

https://scienmag.com/study-shows-hydroxychloroquines-harmful-effects-on-heart-rhythm/

The American College of Cardiology (ACC )has detailed information for its members, and available to the public,  including  their evidence based protocols and algorithms which I have posted since March. 

 

Since you have the background to understand it at a deeper level than most of us I would be interested in seeing what your thoughts were.

 

Travis

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On 5/22/2020 at 10:18 AM, dwilawyer said:

So that appears to be the politics within medicine (the turf wars).

 

So this is the official position of the American College of Cardiology.

 

https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19

 

For @Bosco-d-gama

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7 hours ago, BigStewMan said:

say tomorrow China says they have a vaccine and will share it -- what is the protocol from the FDA -- do we still do extensive testing?  

Could you envision China pimping a bogus vaccine? Wouldn’t surprise me anymore. 

Where did all those bad test kits come from? How many of our drugs come from China>?

I never looked at the FDA site and saw how many drugs are recalled for containing things that should not be in them.  It is amazing, in a very bad way.

 

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts

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10 hours ago, dwilawyer said:

The American College of Cardiology (ACC )has detailed information for its members, and available to the public,  including  their evidence based protocols and algorithms which I have posted since March. 

 

Since you have the background to understand it at a deeper level than most of us I would be interested in seeing what your thoughts were.

 

Travis

Hydroxychlorquine is a drug that’s been in use for over 1/2 century and remains a safe and effective treatment for several disorders. Like most drugs it has its side effects, unwanted things that the drug can do to a person. It is up to the prescriber to know how to deploy any medication. It is up to the patient to report untoward problems with any drug and to track their own responses and allergies to pharmaceuticals.

 

Hydroxychlorquine was trialed in treating covid19 early and reportedly had positive results. Since then that has been shown to be inaccurate or less than accurate. We are now seeing a similar path with remdesivir with studies giving us different outcomes. Viruses are not simple diseases to treat. We see a medical community doing its utmost to bring the world medicines and treatments to curtail a raging and deadly pandemic. Should they or our leaders not express optimism when some appear to work? Guess that depends of who they are more than what they say. IMHO the messages about hydroxychlorquine were expressions of hope - not proclamations of panaceas. IMHO the media despised the messenger more than his message, because IMHO had other leaders said the exact same things they would’ve been reported on much differently.

 

Hydroxychlorquine when used for covid19 is used at doses that approach the upper limits of safe applications for the drug. No mystery there.....this is well understood. Those were the doses supposedly required to obtain results. At the time potential untoward side effects of hydroxychlorquine were considered ‘better’ than the outcome of untreated covid19. That’s a daily trade off when using chemotherapy for cancers. It is calculated poisoning. You aim to kill the bad and not kill the patient. It doesn’t always work.

 

Now we have the complete picture and hydroxychlorquine does not work as hoped. It should not be used for treating covid19. It will still be used for treating other diseases. It is not a ‘lethal’ drug that needs to be removed from the formulary.

 

These are my thoughts. Thanks for asking. 

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1 hour ago, Bosco-d-gama said:

Hydroxychlorquine is a drug that’s been in use for over 1/2 century and remains a safe and effective treatment for several disorders. Like most drugs it has its side effects, unwanted things that the drug can do to a person. It is up to the prescriber to know how to deploy any medication. It is up to the patient to report untoward problems with any drug and to track their own responses and allergies to pharmaceuticals.

 

Hydroxychlorquine was trialed in treating covid19 early and reportedly had positive results. Since then that has been shown to be inaccurate or less than accurate. We are now seeing a similar path with remdesivir with studies giving us different outcomes. Viruses are not simple diseases to treat. We see a medical community doing its utmost to bring the world medicines and treatments to curtail a raging and deadly pandemic. Should they or our leaders not express optimism when some appear to work? Guess that depends of who they are more than what they say. IMHO the messages about hydroxychlorquine were expressions of hope - not proclamations of panaceas. IMHO the media despised the messenger more than his message, because IMHO had other leaders said the exact same things they would’ve been reported on much differently.

 

Hydroxychlorquine when used for covid19 is used at doses that approach the upper limits of safe applications for the drug. No mystery there.....this is well understood. Those were the doses supposedly required to obtain results. At the time potential untoward side effects of hydroxychlorquine were considered ‘better’ than the outcome of untreated covid19. That’s a daily trade off when using chemotherapy for cancers. It is calculated poisoning. You aim to kill the bad and not kill the patient. It doesn’t always work.

 

Now we have the complete picture and hydroxychlorquine does not work as hoped. It should not be used for treating covid19. It will still be used for treating other diseases. It is not a ‘lethal’ drug that needs to be removed from the formulary.

 

These are my thoughts. Thanks for asking. 

Seems to be reasonable for certain people within certain circumstances.  Each of these has a shot of working, just no silver bullet or maybe only 30/70 but to someone with little hope, that's better than sitting on a ventilator if it can be avoided.  Seems the ventilator ends up being just as low a success rate.

 

Does anyone know what the percentages of success rates are outside of letting the virus take it's course?. 

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1 hour ago, billybob said:

China , isolated millions  from the virus as the infection started in Wuhan  , but  Chinese citizens were  traveling abroad spreading the virus  wherever they landed resulting in a pandemic  -who do we blame , China , the WHO , or ourselves ?

 

 
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34 minutes ago, pzannucci said:

Does anyone know what the percentages of success rates are outside of letting the virus take it's course?. 

That's the rub.

 

China reported some anecdotal success with it early on. That was picked up on in other countries as it spread.

 

There was the  pre-publication "study" from France which drew a lot of attention, and also criticism from scientific/medical community which became a political football. That study has since been withdrawn. There was a  second limited study in France that said it had "no effect." Another football.

 

In US the position was it looks promising but we need to wait for the gold standard of studies, controlled study, random, with placebo.

 

However, my doctor said that the people in the trenches were reporting some apparent success when their were no other options. His take on it was that the institutional types in ivory towers tend to be "we need to wait for proper study" whereas in the clinical setting when someone continues to decline you are willing to try some things you wouldn't ordinarily do.  He is the one who said the best thing I could do was take Vitamin D and zinc (he had Dr. Fauci as his ID professor in medical school). Since then the Remdesivir gold standard US study has come out which shows it is effective. 

 

Then you get bogged down in what "success" is in these studies. Reduction in length of hospital stays (Remdesivir), deaths among study participants who are grouped (Remdesivir was deemed to not statistically significant, more analysis was necessary). 

 

My take on it is while the studies are carried out to see what is actually safe, effective, etc., if you are a hospital physician you do what you need to do. The other take is that people tend to put way too much stock in media reports of certain things, and really need to go to the source documents. For a time, it seemed to me, people were "in favor" or a medication, or not in favor of something, as an indicator of their support, or non support,  of an elected official, medical/drug bureaucrat. If we allow ourselves to get drug into the media spin when making medical decisions, that really is a bad place to be. "I want drug X because _______________ said ____________." doesn't really bode well. Fortunately, as least to my knowledge, none of us have been the position of having to make serious decisions, but if we were, I would hope that the focus would be "I discussed this with my doctor/family member's doctor, he discussed the options, what her experience has been, etc., etc. and based on her advice we decided to do X." 

 

I hope I am never in the position of having to make the choice, but based on what I know now, if given the choice of HCQ or Remdesivir I would chose the latter unless my doctor suggested otherwise, in which case I wouldn't hesitate to follow their advice.

 

Travis

 

 

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1 hour ago, dwilawyer said:

That's the rub.

 

China reported some anecdotal success with it early on. That was picked up on in other countries as it spread.

 

There was the  pre-publication "study" from France which drew a lot of attention, and also criticism from scientific/medical community which became a political football. That study has since been withdrawn. There was a  second limited study in France that said it had "no effect." Another football.

 

In US the position was it looks promising but we need to wait for the gold standard of studies, controlled study, random, with placebo.

 

However, my doctor said that the people in the trenches were reporting some apparent success when their were no other options. His take on it was that the institutional types in ivory towers tend to be "we need to wait for proper study" whereas in the clinical setting when someone continues to decline you are willing to try some things you wouldn't ordinarily do.  He is the one who said the best thing I could do was take Vitamin D and zinc (he had Dr. Fauci as his ID professor in medical school). Since then the Remdesivir gold standard US study has come out which shows it is effective. 

 

Then you get bogged down in what "success" is in these studies. Reduction in length of hospital stays (Remdesivir), deaths among study participants who are grouped (Remdesivir was deemed to not statistically significant, more analysis was necessary). 

 

My take on it is while the studies are carried out to see what is actually safe, effective, etc., if you are a hospital physician you do what you need to do. The other take is that people tend to put way too much stock in media reports of certain things, and really need to go to the source documents. For a time, it seemed to me, people were "in favor" or a medication, or not in favor of something, as an indicator of their support, or non support,  of an elected official, medical/drug bureaucrat. If we allow ourselves to get drug into the media spin when making medical decisions, that really is a bad place to be. "I want drug X because _______________ said ____________." doesn't really bode well. Fortunately, as least to my knowledge, none of us have been the position of having to make serious decisions, but if we were, I would hope that the focus would be "I discussed this with my doctor/family member's doctor, he discussed the options, what her experience has been, etc., etc. and based on her advice we decided to do X." 

 

I hope I am never in the position of having to make the choice, but based on what I know now, if given the choice of HCQ or Remdesivir I would chose the latter unless my doctor suggested otherwise, in which case I wouldn't hesitate to follow their advice.

 

Travis

 

 

Agreed, especially the part of anyone making any type of personal medical decision based upon what the media reported or their favored politician touted. This stuff is just way too complex to take any off-handed information to heart.

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