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Thread: Questioning Conventional Wisdom - The virus

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    FP Enthusiast Emeritus mhosea's Avatar
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    Default Re: Questioning Conventional Wisdom - The virus

    Quote Originally Posted by ilikenails View Post
    In the case of chloroquinine, side effects side effects can vomiting, cramps, and diarrhea
    My impression was that experience with chloroquine has been negative for COVID-19. I did not mention this drug.

    I think you have misapprehended my intention of saying "as a scientist". It was not intended as an appeal to authority. My intention was to indicate that the opinion to follow was, in some sense, against my nature. I also felt that, as a member of the club, I was entitled to my opinion. But it was stated only as an opinion, and if you disagree, you are entitled to say so. I have no objection whatsoever, though I would be happier to receive it if it were offered in a less caustic manner. I have been known to change my opinions when presented with sound arguments.

    The premise I articulated was that the clinician determines that the proposed treatment will likely do no harm. I certainly never suggested that such medications be made available without a prescription. At the time I made that remark, Fauci had been advocating for a normal scientific approach of proving that the drug was effective in randomized double-blinded trials before utilizing hydroxychloroquine for COVID-19 treatment except for "compassionate use" circumstances. A little back-of-the-envelope math suggested that if hydroxychloroquine actually does help, it would be weeks at a minimum before any preliminary data was available, and even that would require a bit of magic in order to conjure up the administrative details to put a study in motion. I do not know whether he changed his mind or his preferences became irrelevant, because my understanding is that it is now being used more generally. Whether it is effective remains an open question, I suppose.

    Generally, for a prescription medicine to be approved for something, it should be proven both safe and effective (relatively). We cannot rush the deployment of a vaccine, for example, because it would be a completely new vaccine, and we would have no way to know it was safe. It might or might not even be effective, but having no safety data makes the risk of doing harm very high. In the case of hydroxychloroquine, we do know the drug's side effects, so a clinician prescribing it for COVID-19 knows what to watch out for. While we don't know what dosage would be effective for COVID-19, if any, we do at least know some dosage information for on-label uses. Naturally in a given case it could be contraindicated. I'm not saying it should be used. Rather, that it should be up to the clinician, not the scientist, to determine whether to give it a try.

    The word "parochial" is a segue into another way of looking at it. I used the word "parochial" to mean "having a limited or narrow outlook or scope." The "parish" I had in mind was that of the medical researcher operating in normal circumstances, the concept of the church and its dogma being replaced with the unbending requirements of the scientific method, which in this case mandates the use of double-blinded randomized controlled studies to determine safety and efficacy before approving of the use of a drug. Within this "parish", the scientist is concerned with proof, and he isn't wrong about what is required to establish that proof. While he may feel pressure to proceed as quickly as possible, he does not question his core assumption that proving efficacy is a prerequisite to using the drug. We do have the aforementioned "compassionate use" exception for exigent circumstances, but how can we apply that here, given the way COVID-19 kills when it kills? We don't know who will develop ARDS and who will not, and compassionate use only applies once a great deal of lung damage is done. We're not talking about a cure, rather a substance that is believed to reduce the viral load. You could restate my opinion as asserting that, for this drug, clinicians needed a broader exception than "compassionate use".
    --
    Mike

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    Senior Member dneal's Avatar
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    Default Re: Questioning Conventional Wisdom - The virus

    RE: chloroquine. The reason it is being considered a potential treatment is a Chinese study that showed it was effective in the lab. No, that doesn't mean it will work on people infected; but it doesn't mean it won't. One would assume a medical doctor is familiar with a drug that's been around a long time and prescribed for non life threatening problems like arthritis, risk to specific patients given their medical history, and side effects of the drug.

    Seems like someone who wants to prevent up to 500,000 deaths would also be amenable to a case of the trots if it could save a life... but I'm bemused by silly things.

    https://www.nature.com/articles/s41422-020-0282-0

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    Default Re: Questioning Conventional Wisdom - The virus

    Quote Originally Posted by dneal View Post
    RE: chloroquine. The reason it is being considered a potential treatment is a Chinese study that showed it was effective in the lab.
    That isn't something a scientist would say: it's VERY inexact and misleading. Most people would read that and believe medical efficacy was demonstrated in the lab, possibly on humans. Nope: this wasn't the case. Firstly, the study only tested with the drug could stop the spread of c19 from on cell to another in mice cells. It didn't test for eg a delivery mechanism, so it may well be worthless even if it's not a false positive. Secondly, most small sample results like that ARE false positives! There is no way that a real scientist would claim "a Chinese study that showed it was effective in the lab" - it simply didn't. Which is why - and I shouldn't have to explain this - that overwhelming medical opinion is extremely sceptical.

    Again: what sort of scientist do you claim to be??? (You are that guy, yes?) Spreading false news is bad enough. Claiming fake expertise and spreading it is much, much worse.
    Last edited by ilikenails; April 14th, 2020 at 08:40 AM.

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    Default Re: Questioning Conventional Wisdom - The virus

    Also, for whichever person claimed - with no source - that Fauci said that Trump wasn't advised to lockdown earlier:

    https://www.theguardian.com/world/20...ce-coronavirus

    CNN host Jake Tapper asked if Fauci thought “lives could have been saved if social distancing, physical distancing, stay-at-home measures had started [in the] third week of February, instead of mid-March”.

    “It’s very difficult to go back and say that,” Fauci said. “I mean, obviously, you could logically say, that if you had a process that was ongoing, and you started mitigation earlier, you could have saved lives. Obviously, no one is going to deny that.

    “But what goes into those kinds of decisions is complicated. But you’re right. I mean, obviously, if we had, right from the very beginning, shut everything down, it may have been a little bit different. But there was a lot of pushback about shutting things down back then.”


    ..So the complete opposite. And really -NEVER make claims on contentious subjects without evidence.

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    Senior Member dneal's Avatar
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    Default Re: Questioning Conventional Wisdom - The virus

    Quote Originally Posted by ilikenails View Post
    Quote Originally Posted by dneal View Post
    RE: chloroquine. The reason it is being considered a potential treatment is a Chinese study that showed it was effective in the lab.
    That isn't something a scientist would say: it's VERY inexact and misleading. Most people would read that and believe medical efficacy was demonstrated in the lab, possibly on humans. Nope: this wasn't the case. Firstly, the study only tested with the drug could stop the spread of c19 from on cell to another in mice cells. It didn't test for eg a delivery mechanism, so it may well be worthless even if it's not a false positive. Secondly, most small sample results like that ARE false positives! There is no way that a real scientist would claim "a Chinese study that showed it was effective in the lab" - it simply didn't. Which is why - and I shouldn't have to explain this - that overwhelming medical opinion is extremely sceptical.

    Again: what sort of scientist do you claim to be??? (You are that guy, yes?) Spreading false news is bad enough. Claiming fake expertise and spreading it is much, much worse.
    I didn’t say I was a scientist. Please give it a rest.

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    Senior Member Dreck's Avatar
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    Default Re: Questioning Conventional Wisdom - The virus

    Quote Originally Posted by dneal View Post
    I didn’t say I was a scientist. Please give it a rest.
    It should be obvious by now this person has no interest in a rational discussion. You'd be better off arguing with that Osage Orange growing in the back 40...

    Troll-please do not feed.jpg
    Online arguments are a lot like the Rocky Horror Picture Show.
    As soon as the audience begins to participate, any actual content is lost in the resulting chaos and cacophony.
    At that point, all you can do is laugh and enjoy the descent into debasement.

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    Default Re: Questioning Conventional Wisdom - The virus

    Quote Originally Posted by Dave View Post
    Just going back to the video on denominators. There are two numbers that are kind of known. One is the fatality rate among known cases, and one is the best case scenario if the entire US population is infected and nobody else dies. These are, as of this post being written, 14797/435160 or 3.4%, and 14797/327200000 (figure from 2018) or 0.005% respectively.

    3.4% and 0.005%. That's a big range. It doesn't mean a great deal, other than to say the MCFR cannot get any better than 0.005% in the US, which is pretty low anyway; and it will definitely be worse than this because there will be more deaths. However, there is also the possibility that it could get worse than 3.4%.

    For those who are not inclined to crunch numbers, 3.4% of the total population is a shade over 11 million.
    Actually you can make a case for a worse scenario: the early fatality rate in Wuhan was 17% among known cases - which probably means 8% overall, with about an equal number of cases asymptomatic. That was before extra medical resources were brought in from other areas, etc. If you had a scenario where US medical resources were overstretched for the country as a whole and the virus spread at high rate, then an 8% death rate wouldn't be impossible in the US. This is the happy scenario you might have achieved if Trump hadn't been scared into going against his instincts. (These being the instincts of a man who couldn't even make money in the casino business...)

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