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Drs. Vladimir Zelenko and Stephen Smith: Abandoning evidence-based medicine to promote unproven drugs for COVID-19

Drs. Vladimir Zelenko and Stephen Smith have been claiming that hydroxychloroquine is a miracle drug based on anecdotes. Their shoddy, poorly reported case series are not evidence of efficacy.

If there’s one thing that the coronavirus pandemic has revealed, it’s just how weak physicians’ dedication to science- and evidence-based medicine truly is. Facing COVID-19, doctors have embraced protocols to treat the virus based in the thinnest of evidence, or even no evidence. I discussed this phenomenon yesterday, using as my example the rapid, near universal embrace of the anti-malaria drugs (which are also used to treat rheumatoid arthritis, lupus, and some other autoimmune diseases) chloroquine and hydroxychloroquine, even though the evidence base for them is anecdotal and the existing clinical evidence is either negative or very, very weak. It’s worse than that, though. Now we have doctors like Dr. Vladimir Zelenko and Dr. Stephen Smith promoting the use of hydroxychloroquine and azithromycin, even though the evidence for this drug combination comes entirely from a truly awful study by French “brave maverick scientist” Didier Raoult. Worse still than even that, these two physicians are actively feeding the right-wing quackery promotion machine touting all manner of “miracle cures” for COVID-19. Before I discuss these doctors, here’s a bit of background.

How did these drugs even come to be studied? To recap, based on the observation of 80 patients, Chinese doctors in Wuhan noted that no patients with lupus erythematosis became ill with COVID-19 and hypothesized that the chloroquine or hydroxychloroquine that they were taking might be the reason. (These drugs are also mildly immunosuppressive, hence their use to treat autoimmune diseases.) Of course, during a pandemic, it is people who are immunosuppressed are the very people who most rigorously obey orders to practice social distancing and self-quarantine and thereby protect themselves from infection. Be that as it may, the Chinese doctors started using the antimalarial drugs, and anecdotal evidence of success was reported, leading to randomized clinical trials that were announced by the Chinese government to have been “promising.” (None have been published yet, other than a study published as a preprint last week with so many issues that it shows, in essence, nothing.) None of this stopped China from incorporating these drugs into its recommended regimen. The World Health Organization followed suit, as did several countries, and thus was born a new de facto standard of care for COVID-19 based on, in essence, no evidence other than some in vitro evidence that the drugs inhibit replication of SARS-CoV-2, the virus that causes COVID-19, anecdotes, and incredibly weak clinical trial evidence.

As for the combination of azithromycin/hydroxychloroquine combination, its rise is directly traceable to Didier Raoult, a scientist with a history of data fabrication and irresponsible self-promotion to a level that he has been described as “Trumpian.” He published one study that claimed that the combination of these drugs eliminated SARS-CoV-2 (the virus that causes COVID-19) from the body. It was a study so riddled with methodological flaws as to demonstrate nothing, and his followup study was a singularly uninformative case series. The widespread adoption of drugs that have significant toxicities to treat COVID-19 before there anything resembling adequate evidence has been a massive failure of science-based medicine. Worse, given that the FDA granted emergency use authorization to use hydroxychloroquine and chloroquine to treat COVID-19, we might never know if these drugs are clinically effective because no patient is going to want to risk being randomized to the placebo group in the randomized clinical trials doctors are scrambling to try to complete right now.

Dr. Vladimir Zelenko

Enter Dr. Vladimir Zelenko, who was featured in the New York Times yesterday:

The source was Dr. Vladimir Zelenko, 46, a mild-mannered family doctor with offices near the village. Since early March, his clinics had treated people with coronavirus-like symptoms, and he had developed an experimental treatment consisting of an antimalarial medication called hydroxychloroquine, the antibiotic azithromycin and zinc sulfate.

After testing this three-drug cocktail on hundreds of patients, some of whom had only mild or moderate symptoms when they arrived, Dr. Zelenko claimed that 100 percent of them had survived the virus with no hospitalizations and no need for a ventilator.

“I’m seeing tremendous positive results,” he said in a March 21 video, which was addressed to President Trump and eventually posted to YouTube and Facebook.

Here’s an example of the sorts of videos that Dr. Zelenko has been posting to social media:

Meanwhile, Dr. Zelenko has been making claims like this:

Zelenko is one of a handful contending it should be in widespread distribution to people at higher risk of having a serious case of Covid-19 with mid-level symptoms, most often without even confirming their illness is in fact connected to coronavirus.

He wrote in the emails sent on Friday that his clinic had so far given 669 outpatients the drug cocktail, and that none had died. He attached a spreadsheet in which he listed 54 high-risk cases, including three who required hospitalization.

In an interview Friday, Zelenko encouraged doctors to resist calls from infectious disease experts to prescribe the drug only as part of clinical trials and to critical patients.

“This is a World War III situation — it’s the virus versus humanity,” he said. “If we were to adopt their approach, there would be an extra million dead people.”

There is, of course, zero evidence that withholding hydroxychloroquine from mild cases of COVID-19 will result in an extra million deaths. Dr. Zelenko’s actions and words have been truly irresponsible and unethical. It’s made him very famous, though:

Sean Hannity, the Fox News host, quickly promoted Dr. Zelenko’s claims on his TV and radio shows. Mark Meadows, the incoming White House chief of staff, called Dr. Zelenko to ask about his treatment plan. And Rudolph W. Giuliani, Mr. Trump’s personal lawyer, praised him in a podcast interview this week for “thinking of solutions, just like the president.”

And:

In a phone interview from his home, where he has been in self-isolation, Dr. Zelenko, who goes by Zev, described a dizzying week filled with calls from media and health officials from countries including Israel, Ukraine and Russia, all seeking information about his treatment. Some world leaders, including Brazil’s president, Jair Bolsonaro, are also talking up some of the same drugs as a cure.

“It’s a very surreal moment,” said Dr. Zelenko, who has been practicing medicine for 16 years. “I’m a simple country doctor, you know. I don’t have connections.”

I love the whole “simple country doctor” shtick. Dr. Zelenko is anything but. He has, if anything, shown himself to be a master of Trumpian self-promotion, having become a social media (and old media) star almost overnight by promoting Didier Raoult’s cocktail (plus zinc). He’s even appeared on Rudy Giuliani’s video podcast. There is, however, an interesting update in the NYT article. In earlier videos, Dr. Zelenko has bragged that none of his patients had required a ventilator. In this article:

While dealing with his newfound fame, Dr. Zelenko, who has been practicing telemedicine from his home office, is working to keep his coronavirus patients alive. He said his team had seen about 900 patients with possible coronavirus symptoms, treating about 350 with his regimen. None had died as of Thursday, he said, though six were hospitalized and two were on ventilators.

Can you say “selection bias”? Sure, I knew you could. I predict that, as the pandemic continues, more and more of Dr. Zelenko’s patients will wind up hospitalized, with more winding up on ventilators. He’s been treating patients with mild disease, and, as time goes on, more of those will progress to severe disease.

Here’s the thing. All Dr. Zelenko has is a spreadsheet of some of his patients. I found an image of it, and, as data, it’s a joke. The lack of detail, specifically whether a patient tested positive for COVID-19 or was “clinically diagnosed,” is woeful. Basically, you can’t tell anything from it. It doesn’t even qualify as a well-documented case series. Worse, the combination of azithromycin and hydroxychloroquine can cause fatal cardiac arrhythmias. Dr. Zelenko’s actions are profoundly unethical, as he is prescribing drugs willy-nilly to everyone with COVID-19-like symptoms that are not without risk. That spreadsheet is also a major violation of patient privacy. (HIPAA violation, anyone?)

For a case series testing drugs like these on COVID-19 patients to be even minimally informative, there need to be: rigorous diagnostic criteria, rigorous criteria for who is treated, close followup with objective parameters measured (in this case, time to clear the virus would be useful information), and careful data analysis. Even then, observational case series provide the weakest form of evidence. There are rare cases when they can demonstrate efficacy of a treatment, for instance a normally 100% fatal disease in which a high percentage of the treated patients survive, but these sorts of situations are quite uncommon. The vast majority of the time, case series, even well-done and rigorously reported ones, are not very useful for answering the question of whether a treatment is efficacious, and Dr. Zelenko’s case series is anything but rigorous or well-reported. To my mind, it’s no different than Dr. Mayer Eisenstein’s claim that he observed no autism in his unvaccinated patients.

Unfortunately, Dr. Zelenko is not alone. Wednesday night, an infectious disease specialist named Dr. Stephen Smith, founder of the Smith Center for Infectious Diseases and Urban Health, appeared on right wing Fox News propagandist Laura Ingraham’s show to make similar exaggerated claims for hydroxychloroquine, going so far as to call it an “absolute game changer” and the “beginning of the end of the pandemic.”

I will credit Dr. Ramin Oskoui, a cardiologist, for starting out by sounding a cautious note about how chloroquine and hydroxychloroquine can cause dangerous cardiac arrhythmias in a small percentage of patients and recommending a baseline EKG and regular EKGs during the treatment. Then Dr. Smith launched into his uncontrolled case series:

Drs. Smith and Zelenko Fox News

He notes that in his practice that nearly all of the patients who were intubated were diabetic or prediabetic. One thing that stood out is that two out of “over forty” patients developed EKG changes, which he seemed to view as unimportant. Consider this: that’s as much as 5% of patients. Scale that up to giving the drug to thousands of patients, and there will be a lot of cardiac toxicity; so the drug had better work if you’re going to recommend it, particularly to asymptomatic healthcare workers as a prophylactic or as prophylaxis after exposure to COVID-19.

Here’s another excerpt:

He pointed out that not a single COVID-19 patient of his that has been on the hydroxychloroquine and azithromycin regimen for five days or more has had to be intubated.

“The chance of that occurring by chance, according to my sons Leon and Hunter who did some stats for me, are .000-something,” he said, adding that “it’s ridiculously low.”

I call bullshit here. Dr. Smith dismisses the possibility that his reported results are due to selection bias, but he doesn’t show his work. Your sons did a “statistical analysis”? Show it! And what are the qualifications of your sons to do such a “statistical analysis,” anyway? Such a statistical analysis would depend very much on the assumptions made regarding the endpoints examined. Without knowing those, it’s impossible to judge whether the statistical analysis has any validity whatsoever. I say that Dr. Smith is pulling figures out of his nether regions.

Sadly, if there’s anything that the COVID-19 pandemic has revealed, it’s how weak physicians’ dedication to science- and evidence-based medicine is. I understand. Fear will do that. Many of my colleagues who are on the frontlines and lack adequate personal protective equipment are desperate for anything that will help keep them safe as they take care of COVID-19 patients. There is also a profound feeling of helplessness that overwhelms us as physicians when we face a disease for which we have nothing to offer other than supportive care and hope that patients can ride out the disease and emerge alive at the other end. It’s a humbling and terrifying combination. Moreover, it is all too often ingrained in the culture of medicine that we must “do something” at all costs. Physicians do not tolerate helplessness well.

I’m sure that Dr. Zelenko and Dr. Smith believe they’re helping patients, but they also strike me as, like Didier Raoult, having come to like their newfound fame just a wee bit too much. (In the case of Raoult, it’s clearly a way bit too much.) To be sure, in an emergency like a pandemic, there is a role for trying treatments for which the evidence is less than robust in the name of rushing potentially effective treatments to dying patients. Unfortunately, we already know enough about hydroxychloroquine, chloroquine, and combinations with azithromycin to know that these treatments are almost certainly not “game changers” or the “beginning of the end of the pandemic.” They might have some efficacy, but if they were truly “game changers,” we’d already have evidence of it by now. It is indeed still possible that these drugs impact the course of COVID-19, but it is also possible that, being immunosuppressive and having well-known effects on the heart, they could result in harm without benefit. After all, the history of these drugs as antivirals is checkered and mixed, at best. We will never know for sure if trials are not completed, and, right now, doctors like Drs Zelenko and Smith are hindering progress towards that end, which in the end is far more likely to harm large numbers of patients than help them.

Doctors also need to remember: There’s a political purpose behind the promotion of these drugs by the right wing, and it’s most definitely not to help patients. Rather, the purpose is to weaken the FDA, decreasing its authority and lowering the bar for drug approval as part of an ideological opposition to government regulation, and divert attention from the Trump administration’s criminally incompetent response to the COVID-19 pandemic. To the degree that Drs. Zelenko and Smith participate in that propaganda campaign, they will be complicit in the deaths of far more people than these drugs could potentially save, even if randomized clinical trials ultimately demonstrate them to be effective.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

113 replies on “Drs. Vladimir Zelenko and Stephen Smith: Abandoning evidence-based medicine to promote unproven drugs for COVID-19”

Dr. Wagstaff cautioned that the tests conducted in the study were in vitro and that trials needed to be carried out in people.

I almost always note that this type of sentence comes pat the halfay point of such articles, and with no further discussions. It is just an obligatory disclaimer that goes right by most people.

Your effort to dispute the effectiveness of hydroxychloroquine with zinc and Azithromycin to compact infection will fail. Allegations will be shamed by evidence. Front line usage by doctors around the world are demonstrating that you are wrong. Simply go to clinicaltrials.gov searching using Corona Virus with Hydroxychloroquine, there are 68 studies with 30 countries. Dr. Vladimir Zelenko was treating 1,000 patients while you were not. He will be releasing a report next week and has submitted data to FDA. The key is to treat early. When someone is placed on a ventilator your survival rate is less than 50%.

A ” simple country doctor”? SRSLY

Dr Zev is based in Kiryas Joel ( see Wikipedia entry): an enclave of Haredi, followers of a particular Brooklyn rebbe located in suburban Orange County. There are over 20,000 residents, most of them children ( it has the lowest median age in the US and a high poverty rate based on large families). There are huge groups of large multi-family homes/ apartments clustered on hillsides, densely packed together. Children attend religious schools located in the town.

Bad medical advice to a captive audience during an onslaught of a highly transmissible disease. I hope he’s not the only doctor available. These poor people.

I found a few articles:
— Dr Z has been asked to stop making videos about COVID-19 by town leaders
— Rabbi Teitelbaum, 73, may be ill
— the governor has not made KJ a containment zone because of high rates of infection

The reason the town leaders stated they did not like dr z telling everybody how high the infection rate is in their town .

I assume that this guy is the equivalent of your bog standard GP in the UK? In which case I’m amazed he’s managed to create this treatment regime. Our GP can barely keep from f#£king up sending a prescription over to the Pharmacy. Let alone find time to perform drug trials.

“Simple country” anything is a huge red flag. I recall reading that in the US Court for the Eastern District of NY, one of the attorneys started his objection with the “Your Honor, I’m just a simple country lawyer” gambit. The judge responded, “I’m just a simple country federal judge, and you’re overruled.”
In any case, the Satmarer Chasidim have a very troubled relationship with the modern world of the 17th Century.

Mr Walter I believe the poor religious Jews are very lucky to have dr Zelenko . Iam betting Kiryas joal will have a much lower death rate than

How foolish of you, and how insincere your stated hope. The good doctor already had his antennae tuned to the plague that was to hit the USA before it ever got here. He followed the waves of that plague as it struck Europe before it got here, and was well prepared once it got here. Unlike other Jewish communities in NY, which also have high, dense populations, the number of deaths in HIS community was ONE death, whereas other had a minimum of 75, and up to 375. That’s a .999 batting average! So much for your amateurish medical understanding and stupid comment.

That aged well.
Zelenko released a video over the weekend, addressed to the Kiryas Joel residents, in which he accused town leaders of orchestrating multiple investigations against him. Zelenko accused three men — Gedalye Szegedin, the town administrator; Mayer Hirsch, a developer and Joel Mittelman, the chief executive of the main health care provider in Kiryas Joel, where Zelenko used to work — of being responsible for the deaths of 14 Jews who died of Covid-19. The three did not act quickly enough in closing the town’s synagogues and schools at the beginning of the pandemic, he said.
https://forward.com/fast-forward/447020/zelenko-hydroxychloroquine-kiryas-joel-hasidic/

“If there’s one thing that the coronavirus pandemic has revealed, it’s just how weak doctors’ dedication to science- and evidence-based medicine truly is.”

At least, that’s not me saying it, now…

All Dr. Zelenko has is a spreadsheet of some of his patients. I found an image of it… Basically, you can’t tell anything from it.

The spreadsheet has PHI on it (initials derived from names, specific dates, specific ages >=90). Dr. Zelenko has violated HIPAA through public disclosure of PHI.

Naughty, naughty. (Did nobody notice???)

The poor doctor himself had suffered a contagious disease while simultaneously overcoming cancer! He sent his nurses to the peoples homes and telecommunicated with them via some zoom-like program, unable to be one on one with his patients except through his nourse proxies. You can see his devotion to his patients and his meticulous recording, and here comes some commenter shooting from the hip, probably just jealous of the success this good doctor could accomplish, let alone also recovering from his own dreaded disease at the same time.

Fox this morning put a videotaped question from quack Oz to Dr. Fauci asking what he thought about the Chinese studies…to which Dr. Fauci said the data was not robust. I hope more physicians will believe Dr. Fauci over Oz.

You’re a troll for BigPharma – with no regard whatsoever for human life. You denigrate a doctor who has a 99% batting average, calling him Dr Oz. Shame on you, you who’d rather support abortions, but deny susceptible people of a worthy medical protocol. If Obuma had a son, you’d be his.

Dr. Fauci trained as an internal medical doctor, and in his career specialized in immunology. He actually worked in treatments for some formally fatal diseases, and did important research into HIV. He has been part of the National Institute of Allergy and Infectious Diseases since 1984. All of this information is available here: https://en.wikipedia.org/wiki/Anthony_Fauci

Dr. Oz is a heart surgeon with a TV show. Now please list Dr. Oz’s awards and honors, and compare them to the list on Dr. Fauci’s wiki page.

Do you see a difference between them?

As I wrote in previous comments, chloroquine and hydroxychloroquine may work for autoimmune diseases where the immune system turns against self; but cytokine storms, acute respiratory distress syndrome, is an exponential increase compared to autoimmune. In addition, not just me; but others, have pointed out that those most at risk from COVID-19 because of age and/or comorbidites (many have several comorbities) together with the assault of COVID-19 could, in fact, experience severe side-effects, even possibly increasing risk of death.

The approach based on desperation and emotions might be acceptable if the case-fatality rate was much much higher, e.g., 80%, since would have little to lose; but given, even with those at highest risk being less than 15%, the other 85% if use untested drugs may be victims. I read a book a long time ago that compared various medical cultures, Lynn Payer’s “Medicine & Culture”. One thing she pointed out is that American medicine differed from other European nations in that we have to do something, act, even if increases risk. Historically we have adopted many procedures, some worked; but others proved either worthless or harmful.

And as I wrote before, despite 40 years of experience and education, I hope I am wrong as human life is much much more important to me than my opinion, regardless of how strongly scientifically based.

To Narad,

I’ve only ever had orange marmalade. I have had quince jelly (my mother used to make it) that was quite lovely. But still not lemon curd.

I cannot allow an implicit insult to the noble quince pass without registering an objection.

To our everlasting honor, here in the US we have key lime marmalade, a comestible of unsurpassed wonderfulness.

Dr. Fauci was SPECIFICALLY asked in a TV interview 4/3/2020 how many people who had been taking Plaquenil (hydroxychloroquine) long term for lupus and other conditions had been hospitalized for Covid-19. HE IGNORED THE QUESTION!. This information is easy to come by since everyone admitted at a hospital gets a complete medical history. Wouldn’t you want to know if the proportion of people hospitalized for Covid-19 who also had been on long term Plaquenil therapy was miniscule compared to their proportion in the general population? If this were true, then that would be ANOTHER strong suggestion that pre-medicating with Plaquenil prophilactically prior to getting infected, or at least starting treatment extremely early, and not delaying to wait for a confirmation test that could cost you precious days while waiting for results, as Dr. Zelenko advocates would keep you out of the hospital and give you milder disease.

Academic doctors have their place, but they are not practicing in the front lines, and the studies they advocate take months and years to yield results. That will not help NOW. You have to take some reasonable chances here. Plaquenil cardiac rhythm side effects occur RARELY, and in a 5 day course the chances of retinal damage to occur are infinitesimal. But if corona virus infection lands you in the hospital, you have 1 in 20 chance of dying; more if you have other risk factors. Using Dr. Zelenko’s drug combo if perfectly REASONABLE under this circumstances. And if Plaquenil if eventually PROVEN scientifically to work, get ready for President Trump to get massive credit for having advocated for it early.

This information is easy to come by since everyone admitted at a hospital gets a complete medical history.

You’re funny. This sort of information is not easy to come by, and, given how small the proportion of the population taking drugs like hydroxychloroquine is, you vastly overestimate the likelihood of finding anything significant. Dr. Zelenko is so supremely irresponsible that it beggars imagination.

Orac, what are your qualifications to dispute what are these doctor’s treatments of a virus that has deadly potential? There are hundreds of doctors around the world using this drug and quite successfully. They also all seem to have prescribed it to themselves to have on hand in case they should contract this nasty virus. You on the other hand are welcome to go without. Why you would choose to spin such a scurrilous piece to impugn these drugs which seem to be the best beacon of hope thus far? Must be political, and it’s a shame and a sham to deride a potential life line to people dying of this disease just to make a political point.

@Rocki-Roddy

There are hundreds of doctors around the world using this drug and quite successfully. They also all seem to have prescribed it to themselves to have on hand in case they should contract this nasty virus.

Citation needed. Which doctors?

If the drug is found scientifically to NOT work, get ready for President Trump to act like he never said anything, lie about saying anything and blame others.

Dr. Fauci was SPECIFICALLY asked in a TV interview 4/3/2020 how many people who had been taking Plaquenil (hydroxychloroquine) long term for lupus and other conditions had been hospitalized for Covid-19.

Where might that be?

To repeat: there are actual antivirals, approved for similar viruses than coronaviruses (for instance, hepatitis C virus), that may work:
Guangdi Li Erik De Clercq
Therapeutic options for the 2019 novel coronavirus (2019-nCoV)
Nature Reviews Drug Discovery 19, 149-150 (2020)
doi: 10.1038/d41573-020-00016-0
For gene duplication, RNA viruses need RNA polymerase that work on RNA template. These drugs prevent this. Much better than a antimalarial drug, that can work only. by accident. There are a clinical trial, too.
You should really read what Orac wrote: one patient died during Raoult’s trial, but he did not count him. Neither are people transferred to ICU counted. And he did measure only (but not always) viral load, and did not give any clinical data. A shameless self promoteur, obviously.

Blah-blah-blah-blah. That’s not doctoring, that’s Drama Whoring.

That will not help NOW.

Uh-huh. You know what will help now?

NOT MAKING A BAD SITUATION EVEN WORSE BY ENDLESSLY FUCKING GUESSING.

Forgive my potty mouth, but these goddamned yahoos will be the death of us all.

@ H. Cerri
I think that is a key question (is plaquenil use protective against COVID-19() but Dr. Fauci could not know the answer yet. The government has access to medical claims data, and can figure out who is using Plaquenil, but it will take some clever data mining way later to figure out who did NOT go to hospitals to seek treatment for coronavirus. It is also interesting that lupus and RA are not listed as complicating factors. People like me think of that as a clue, but people on here think I’m a dangerous simpleton for making an observation like that (you know: not double blind, not refereed or published, and definitely not thought of by them).

How would you find out if the people taking plaquenil came into contact with the coronavirus? How would you control for people taking plaquenil behaving in a different manner to the average person? After all, people who are ill anyway have less contact and take more care than people without.

Maybe you should realise that, if it was that simple, experts are already doing it or have already examined the idea and abandoned it.

It is also interesting that lupus and RA are not listed as complicating factors.

Why should they?
Be complicating factors, I mean.
Actually, my question could also be “why mention lupus when you already have to mention more prevalent risks like diabetes, heart conditions, etc”?

You know what else isn’t listed as complicating factors? Psoriatic arthritis and Crohn’s disease (or IBD in general).

Saying that RA and lupus aren’t complicating factors means nothing.

with 50 thousand dead people from Covid19 , surely some of them should have R arthritis or lupus . If few of them do ? you have the answer Hydroxychloroquine helps .

I somehow suspect that the staff of hospitals getting swamped with COVID-19 patients have more pressing things to do than break out the data on patients taking Plaquenil, and all the other information that would have to be gathered in order for it to be worth the effort. At least that’s the case here on Earth. It may be different on your planet.

(None have been published yet, other than a study published as a preprint last week with so many issues that it shows, in essence, nothing.)

Someone pointed out on Pubpeer that the authors’ claim that researchers were blind to the HCQ / not-HCQ status of the 62 cases in that study was a lie, as they sent out a press-release partway through claiming that 19 of the 20 patients treated so far with HCQ had “improved significantly”.

Then they recruited another 11 patients for the HCQ group, still only had 19 “improved significantly”, and decided that is was a good time to finish the study and publish before the stats got even worse.

Speaking of the “dangerous allure of miracle drugs”, support for medical marijuana legalization is a bipartisan affair, with Democrats somewhat more likely than Republicans to push it, for indications ranging from shaky to unsupported (in Kentucky, a House bill provides for medical pot usage to treat MS among other things).

https://actionnetwork.org/user_files/user_files/000/026/543/original/MedMen_Polling_Event_Presentation_7.17.18_FINAL.pdf

Attempts to weaken the FDA are, however, overwhelmingly right-wing.

Hopefully he quits his day job — although not sure goofs preaching on TV would really keep us much safer. I think I have immunity from low grade information but you never know how someone else’s infection will bother you. I’m guessing Reiki is safer and just as effective. Didn’t realize respected agencies were getting on that bandwagon. Ugh. Keep up the good information!

I’m rather surprised to have not heard more about the use of anti-virals and anti-retrovirals against COVID-19. Does anyone know about new studies?

In other news…

KInsa, who make “smart thermometers” track and map fever data, show that social distancing works although in high density cities, it may not be enough
I though that technology mavens at RI ( I’m not one but I like maps) might want to look into this company.

Someone I know reports that a relative is buying up cheap cruise ship stocks, expecting a rebound. I wouldn’t: I think that their business will be totally transformed by the current situation PLUS I don’t like how they operate. I did look at the precipitous fall of airline stocks over the past year. Oy vey!

I’m rather surprised to have not heard more about the use of anti-virals and anti-retrovirals against COVID-19. Does anyone know about new studies?

ARVs don’t look so hot.

In South Africa, our national airline SAA is in business rescue. SA Express, a short haul/regional carrier, was in business rescue but now the Business Rescue Practitioners have concluded that with Coronavirus, it cant be saved and they have begun the liquidation process.
What’s the betting that a number of other airlines and some of the cruise liner companies will also go under?

I’m rather surprised to have not heard more about the use of anti-virals and anti-retrovirals against COVID-19.

In my corner of the world, the French Senate released recently their own summary on the situation.
There are a few antivirals being used and/or studied. It’s definitively not “it’s chloroquine or nothing”, as some would tell you…
(It’s in French, obviously – but the drug names are recognizable, and they included a bibliography! I cannot tell you how I was glad to see footnotes giving references to scientific articles)

Should not this be in Science or Nature? 🙂 Fascinating summary.

I must admit that my vocabulary is a bit weak in the diseases area.

@ Athaic

“I cannot tell you how I was glad to see footnotes giving references to scientific articles”

I must say I’ve gone through quite a bit of reports from institutions such as the french Senate, and I find that such reports are very lenient on properly referencing external material. And it’s not only the case in medical matters, but in almost all matters.

Comparatively, I find analogous reports in the US much more thorough.

Merci beaucoup I can read French to some degree. Sometimes.

Unfortunately, the article doesn’t come up in this machine’s reader. I imagine that some anti-virals would work.
A few weeks ago there was talk about utilising “AIDS drugs” but I haven’t heard any thing about them recently- perhaps wishful thinking. I’ll try to look for related material perhaps by name of drug.

A few weeks ago there was talk about utilising “AIDS drugs” but I haven’t heard any thing about them recently- perhaps wishful thinking. I’ll try to look for related material perhaps by name of drug.

Ahem.

“I’m rather surprised to have not heard more about the use of anti-virals and anti-retrovirals against COVID-19. Does anyone know about new studies?”
In Israel, four medical centers are taking part in a multinational study of a Japanese antiviral. It was just an item I saw in passing so I don’t have any more info, but I will post anything more that I find out later.

Got hold of a cute opponent to science in my little corner of the world.

May we one day bring this kind of interstellar-level bullshit to an end before we start thinking of colonizing space. Always amazed that our species managed to come down from the trees…

“Always amazed that our species managed to come down from the trees…”

Have you met our species? We most likely fell out.

@ has
@ John Kane:

You are correct.

Perhaps we can understand human nature if we discern the pushers from the fallers.

Always amazed that our species managed to come down from the trees…

They fell or were pushed by annoyed neighbours.

“Far out in the uncharted backwaters of the unfashionable end of the western spiral arm of the Galaxy lies a small unregarded yellow sun. Orbiting this at a distance of roughly ninety-two million miles is an utterly insignificant little blue green planet whose ape-descended life forms are so amazingly primitive that they still think digital watches are a pretty neat idea…. Many were increasingly of the opinion that they’d all made a big mistake coming down from the trees in the first place, and some said that even the trees had been a bad move, and that no-one should ever have left the oceans.”
Speaking of coming down from the trees…

Ah… H2G. Thanks for reminding me of this masterpiece. I’ve never looked at mice the same way since then.

BTW, if you’ve ever wondered what the question was whose answer was 42, here’s an educated guess

Another theory about 42 is that Adams, a computer scientist, used “42” because the ASCII symbol represented by 42 is the asterisk. Asterisks are often used as placeholders, so the answer to the ultimate question is “anything you want it to be”.
It’s the theory I like best.

The reason behind ’42’ is that it’s an intrinsically funny number. Some numbers are just funnier than others. Sid Caesar’s legendary stable of comedy writers knew that and sometimes spent hours trying to find just the right number to use in a sketch.

Why aren’t these gentlemen- especially the one who violated patients privacy – in deep legal trouble? They don’t seem to be following human subjects regulations (and, as you say, HIPAA).

You assume that the patients never gave him permission. I think your assumption is just an assumption …

Sunday 4/5, 7:47PM EDT
Asked by a reporter whether he was playing Doctor with his hyping of hydroxyhclorogquine, Trump’s reply just wandered into an extended explicit pitch for Right To Try legislation.

Meanwhile Axios is reporting that Trump’s enthusiasm for hydroxyhclorogquine is coming largely in the wake of the influence of… [wait for it… ] Sean Hannity and Rudy Giuliani. And the pool report of the presentation noted that while Trump was delivering an ode to hydroxyhclorogquine as part of his scripted remarks earlier in the press conference, Anthony Fauci was off in a side room, avoiding eye contact, and “practicing self-calming techniques”.

It’s hydroxychloroquine, NOT hydroxyhclorogquine (as you wrote TWICE)… Can’t get anything right? Having a bad day. Repeating a rumor that was pure speculation from the beginning as your source is hardly convincing. But I’m sure Orac will cheer on such snarky comments. Expecting mine will never see the light of day. Censorship.

There’s actually quite a bit of evidence for Zelenco’s treatments – the 62 patient Wuhan trial, Dr Raoult’s trials and others. Maybe not 100% proven but better than nothing.

@ tim3333

Not better than nothing; but when research is so poorly done it can be worse than nothing, that is, people like you and Trump may jump on it, only to find not only it doesn’t work; but actually does harm, even increasing deaths. The vast majority of those dying from COVID-19 are elderly with one and usually several comorbidities. Add the assault of COVID-19 and they are extremely weakened, which means that, for instance, chloroquine and hydroxychloroquine, that have both mild side-effects and severe side-effects, for these people, could end up with the severe side-effects. Though the stats keep changing, currently around 5% of lab confirmed cases of COVID-19 result in death. That means that 95% survive. If chloroquine and hydroxychloroquine don’t help, giving it to many of those who would have survived could actually kill them. So, desperate uninformed grasping at unproven treatments is just plain foolish. If, however, the case-fatality rate was above 90%, maybe worth a try; but even then could kill those who would have survived.

Read carefully what Orac and Dr. G wrote about chloroquine and hydroxychloroquine both on this blog and Science-Based Medicine, all excellent blow by blow showing just how flawed the claimed studies were. Read really carefully.

Isn’t it infuriating that Trump persists about chloroquine?
Isn’t there someone close to him with enough brains to tell him that the drug no longer looks like a “miracle cure”?
Isn’t he supposedly surrounded by business people who are experts in PR- if not medicine or science- who should just tell him to shut the fuck up already?

-btw- television reporting shows the tent hospital located in a deserted CENTRAL PARK, NYC: you can hear birds.
The peak for NYC and nearby areas might be later this week.
As far as I can tell, people are following the rules around here. No traffic, most businesses closed, parks closed ( I did find an open site near one of the rivers, probably open because it has a boat ramp) there were about 7 people total in a large area. people have been fined for gatherings of over 10 people.
Restaurants advertise their takeout and delivery services with large signs- some handmade.

Even from this side of the Pond its easy to see that Mr Trump wouldn’t listen to anyone who disagreed with him. Why would he? His entire life has been lived in the lap of powerful luxury. Who would have dared? Might (or money) makes right.

To be honest, I suspect the PR guys probably have the best chance of getting him to STFU. After all, PR is just polishing a turd and calling it a lipsticked pig. He doesnt have to change his opinion, just keep quiet about it.

just keep quiet about it

And here is the problem. Preliminary evidence suggests that Trump cannot keep quiet about anything with potential political repercussions.
Well, he does keep quiet about his tax returns. Maybe labeling every topic “personal financial matters” may do the trick.

“Isn’t he supposedly surrounded by business people who are experts in PR who should just tell him to shut the fuck up already?”

Well, we now know he IS surrounded by business people who stand to make some sweet profits from mass sales of hydroxychloroquine. Follow the money…

It is uninformed wild speculation to suggest Trump & Co. are trying to make money off HCQ, a 5-cent a pill generic. Look into who is invested in UNITAID and working with China to sell Remdesivir at $1000US/dose.

Oh yes, that would be Soros & Gates who’re deeply invested in Remdesivir through their UNITAID connections to China. The same place Dr. Fauci funneled more than $1 billion in US money to continue antiviral work that had been stopped in the USA for safety reasons.

Bob, you had three weeks, and all you came up with was this?

Useless Eaters, man. Rima Laibow weeps.

If readers of this article cannot see that it is pure, unadulterated bovine excrement, they need to have their brain function checked.

Orac uses less factual information than he claims the good Drs. he attempts to smear are using.

It’s little more than a compilation of innuendo, character assassination, and name-calling. Just what is Orac’s age? 12? 13? (with apologies to all other 12 and 13-year olds).

Other studies have shown a 92% cure rate within one week for HCQ + Z-Pak. A “cure pack” costs $20 (a six-day supply), after which for most typical patients who do not have serious underlying problems a complete cure with antibodies in the blood is obtained. Even those on their death bed have quickly responded to this combination. There is little evidence that short-term modest dosages of HCQ have any debilitating effects on patients, even those with known heart conditions. Naturally, the drug is only given under the care of a physician and it is doubtful that any patient suffering serious heart arrhythmia would be prescribed HCQ for any condition.

The anti-HCQ hysteria is akin to TDS.

So why is Orac so quick to smear and discredit something that is inexpensive, works, and is widely available? Particularly when there is no other ammo in the arsenal? Does Orac suffer from TDS?

Do I detect some anxious partisan motives? Snarky comments about other people… brash name-calling… is not a tool of someone who can make a sound argument with evidence, and there is no question that is not what was accomplished by Orac’s screed (perhaps more appropriate, Orac’s rant). So smearing the people involved becomes the tactic. It’s old, Orac.

Curious that such a position would be taken.

I know for a fact that physicians and nurses who treat in local hospitals are taking HCQ as a preventive. I suppose they’re all just a bunch of right-wing lunatics trying to promote the Trump agenda.

But wait a second… the George Soros/Bill Gates supported drug, Remdesivir at $1000 per dose, is on the horizon. True, it is NOT a cure, but it does claim to reduce typical infection time from 14 to 10 days (twice the time of the 5-cent a pill HCQ to effect a cure).

I smell something unsavory about this shoddy “article”.

Now, quick, Orac, take this comment down… you wouldn’t want it to influence anyone with the capacity to think for themselves.

Dr Z’s treatment has saved many lives. How many lives has your lack of treatment saved?

There is no evidence that Dr. Z’s treatment has saved a single patient. Certainly his incompetent “case series” is no such evidence.

” I predict that, as the pandemic continues, more and more of Dr. Zelenko’s patients will wind up hospitalized, with more winding up on ventilators. He’s been treating patients with mild disease, and, as time goes on, more of those will progress to severe disease.”

Dear Dr Asshole., I am one of Dr. Zelenk’s patients. I was NOT originally given hydroxychloroquine by the first physician who saw and tested me, and my symptoms got worse, the original doctor disappeared, I tracked down Dr. Z and now I have 99% NO SYMPTOMS of Wuhan virus (do you need a heimlich when we call it where it comes from?).

You are right, we need many more studies, but not by your cohorts who WORK FOR GILEAD. Between Dr. Z and Dr. Didiot and many THOUSANDS of other Drs who are prescribing it, we know it works.

More important, we need a pledge by the ANTI TRUMPIAN people like you that if you or your family are diagnosed with the virus, THAT YOU WILL NOT TAKE IT.

Until you make that PUBLIC PLEDGE, you should hang your head in shame for your vilification of Dr. Zelenko, who undoubtedly has saved MANY THOUSANDS MORE LIVES THAN YOU HAVE.

I find many slouch physicians do not read the research literature, many alas confine their reading to the clinical literature. Hence they are unaware of the primary research that indicates the potential of the components of the combination that Dr Zelenko used in his treatment. Its documented. Just use Google Scholar. Put in search terms ‘virus’ ‘zinc’ etc etc don’t let TDS put you off doing a thorough going through the results. I have done it. And it shows that Dr Zelenko’s rationale for including zinc in his treatment has a basis -certainly speculative – but nevertheless a basis in basic research on these and other viruses. He has had the courage to try save his patients when there were and still are, very few other options.
And by the way what did Trump do wrong? Did he shut down travel from China too early, or too late? You seem to be on the bandwagon, that he did he not use his crystal ball to foresee he would need a stockpile of ventilators, and like-wise he didn’t presciently get CDC to prepare tests for the virus … President Trump listened to Dr Fauci in everything so far up until maybe only recently, except he went against Fauci’s advice and shut down travel (just when about everybody threw hissi-fits saying how racist of Trump to to that) so if Trump did wrong it was in following the advice of the likes of Dr Fauci and the CDC men. You don’t mention the disastrous policies of De Blasio and Como in New York city and state with regards to ordering that elderly corona virus infected patients must be admitted into nursing homes, which resulted in huge losses in those homes … If you hadn’t gotten side-tracked from your tirade against Dr Zelenko to bash Trump, I wouldn’t have grounds to say this, BUT you lose credibility my friend, it seems that you’re just on a Trump bashing exercise, and anything remotely positive that he’s done you instinctively seek to trash and pour scorn on it.

I find many slouch physicians do not read the research literature, many alas confine their reading to the clinical literature.

You don’t say, David. Now, how do you go about doing this?

Hence they are unaware of the primary research that indicates the potential of the components of the combination that Dr Zelenko used in his treatment. Its documented. Just use Google Scholar. Put in search terms ‘virus’ ‘zinc’ etc etc

Oh, be a sport, Scott, and choose some of the items you found most compelling.

There is some anecdotal evidence that this works. But, you have to boof it (“it means to fart…, I like beer” — supreme court justice, Brett Kavanaugh). But, for it to work, you have to stick the zinc really far up there like with a broomstick or something. What is really not that surprising to me is that 1 in 10 do not seem to mind.

I think aggressive propaganda can end very badly for many citizens. We can get a negative effect from this. I think that it is always worth trusting, but checking and therefore I believe that the media should do a high-quality investigation of medications as well. I really hope that this trend will only gain momentum and we will become more educated and smarter due to the fact that we will be covered. Although of course people will perceive it sluggishly.

You accuse others of being grifting doctors. But your’e the grifting snied sniper. Good doctors out here are saving lives while you sit in your armchair sniffing Disney-milk …

Which peer-reviewed journal was this manuscript submitted to? Or did you just publish it on a preprint server without submitting it to a journal?

Oy, vey. It’s an MDPI joint.

If the preprint is published in a journal, we will link directly to the journal version from the abstract page and PDF, making sure that readers have access to the latest version.

They don’t seem to bother keeping stats that I’ve noticed.

Be careful what you wish for, Vladimir. I might actually go through your “study.”😉

BTW, which peer-reviewed journal did you submit this manuscript to? What is the status of its peer review? Given that it’s been over a month and a half since you posted this, I’m guessing that peer-review is probably not going swimmingly.

Someone pointed out on Pubpeer that the authors’ claim that researchers were blind to the HCQ / not-HCQ status of the 62 cases in that study was a lie, as they sent out a press-release partway through claiming that 19 of the 20 patients treated so far with HCQ had “improved significantly”.

Then they recruited another 11 patients for the HCQ group, still only had 19 “improved significantly”, and decided that is was a good time to finish the study and publish before the stats got even worse.

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