It seems that we just can't get away from HCQ and related commentary yet, not when The State's Times has just announced on its front page, a day or two back, that Remdesivir is now approved for treating late-stage coronavirus patients in Singapore, thanks to a breaking paper showing that it reduces recovery by about four days (note similar study in The Lancet showing no improvement ignored). Eh, I do hope it helps, but more on that later.
Meanwhile, more confusion reigned at the WHO, as they somehow asserted that asymptomatic transmission is "very rare", before the paint dried on their new face mask guidelines, which seemed to have been driven by concerns over this modality of transmission (and right as local researchers declared that half of Singapore's new coronavirus cases were symptomless). It would have to be clarified that true asymptomatic carriers - who never develop any symptoms throughout their infection period - are indeed rare, but presymptomatic folks who do not manifest symptoms early on are common, and can indeed spread the virus during that early period; which was, like, how almost everyone interpreted "asymptomatic spread"? Anyway, the WHO has backtracked on the statement, but yeah, not really listening anymore.
As we said, the outcomes are predetermined
As the unwinding of #Lancetgate continues, the most staggering observation was just how paltry the attention it had received in the mainstream FAKE NEWS. Despite its extremely far-reaching and incomparably-relevant implications, there was only mild coverage in a handful of relatively fringe outlets, because why would anybody at all be interested in a coordinated effort to discredit a potential coronavirus remedy?
There would be more pointed outrage on Twitter and other social media, but the visibility of such in the English-reading world has probably been somewhat dampened, due to many of the anti-HCQ mafia's most ardent critics residing outside the Anglosphere - a reminder of just how much one's language proficiencies can colour one's perspective of reality. Raoult's French believers (we'll be relying on their analysis for much of the next section) have been particularly loud, such as in pointing out that some fifty-over countries have been quietly dosing their populations with HCQ, to what one suspects is some success in early prevention. Coincidentally, none of Lebanon, Costa Rica, Saudi Arabia, Malaysia, India and Italy etc appear to have English as their dominant language, so it's perhaps not too surprising that the news and meta-analyses aren't getting through to the U.K. and U.S. in particular.
On this, a Yale epidemiologist's call for early outpatient treatment with HCQ in the American Journal of Epidemiology appears to have been outright ignored in the mainstream media, as they preferred instead to rehash the old much-critiqued Veterans paper, just-published in Med. Seeing as how some states have apparently been continuing with HCQ, however, and how others are suing for the right to prescribe it, we might or might not get some real answers in the future.
And on the mysterious Surgisphere magic firm, they have basically erased their online presence, as dazed observers from the medical community slowly came around to just why nobody at The Lancet or the NEJM or any number of other big-name journals, bothered to question as to just how what was essentially a one-man company making outright fantastic claims, could have assembled the wealth of data they claimed to have. At least some consequences were to be had, as one of the authors just had his adjunct appointment terminated by the University of Utah; it seems that this worthy was related to Surgisphere's CEO by marriage, which may make for some slightly-awkward upcoming family reunions.
HCQ Dosage Debate
#Lancetgate appears to be old news, though, what with the French Twittersphere now pushing #Recoverygate & #Oxfordgate, targeting the slightly-sketchy HCQ dosages employed in Oxford's RECOVERY trial, as discussed in the previous post. This new hashtag push owed much to an exclusive interview by French online newspaper France-Soir (who had notably previously snagged an interview with one of the #Lancetgate authors, too), of the honorable Prof. Landray, who was co-head of said trial.
The questioning of the high-seeming dosages had begun immediately once and even well before the results were revealed, with India's ICMR going as far as to write to the WHO in protest, but yeah, it's the WHO. Frankly, I'm not even sure I want the France-Soir interview to be legit - though it seems to be - from the answers given. Landray would first affirm that the high doses were chosen to ensure that the HCQ blood levels were high enough to have a chance at killing the virus, which I guess most can't verify independently; the kicker however came when it was then revealed that the dose was decided to be "in line with the sort of doses that you used for other diseases such as amoebic dysentery", and that he wasn't sure about the max HCQ dose in the U.K., but that "it is much larger than the 2400mg, something like six or 10 times that".
Well, these statements prompted an absolute outroar amongst horrified mostly-French commentators, beginning with the observation that 24000mg of HCQ was so obviously not okay (some defenders have trotted out a case where a teen survived a 22000mg dose, but I hope it self-evident why this is not an ideal direction to argue from). The horror then intensified, when a French M.D. mused that HCQ isn't generally prescribed for amoebic dysentery, and the usual cure is hydroxyquinoline, for which the stated dosages do make sense. Raoult himself couldn't resist chipping in on the unthinkable, no doubt after much pinging from his many followers.
It was further noted that the 2400mg dose was indicated for kids weighing just 40kg too, which did not exactly inspire additional confidence in the study protocol, as gleefully reported in several French publications, none of which will likely gain much currency in the world of English propaganda. Indeed, the RECOVERY trial's heads seem to be wavering from their initial messaging of HCQ being "quite toxic" (this presumption apparently backed by their Evidence Service Team, who stated that "[Safety of HCQ]... is an unjustifiable assumption... there is no guarantee that, because a drug is safe at one dose, it will be safe at a higher dose"), to insisting that the doses were not toxic, because there were no additional deaths - well, so which is it? Can't have it both ways, surely?
I'm not sure whether #Recoverygate is going to get as much traction, although it's not looking too good on the transparency end, with involved professors seemingly going around shutting down informed opinion and analysis on Twitter. Finally, there had been some muttering about the strange timing of the RECOVERY trial's shutdown of their HCQ arm - right on time to smother #Lancetgate - which had been explained as a mere coincidence. Well, as an intelligent Twitter user has noted, this seems to imply that all the other treatments ongoing in the other five arms of the study, must be working rather better; do forgive me if I'm not buying into that explanation just yet...
That bad, huh?
This cynical stand was only bolstered by a leak from a French former health minister, of a Chatham House discussion; for those not in the know, such talks are supposed to be under Chatham House rule, in which anyone who comes to the meeting is free to use information from the discussion, but is not allowed to reveal who made any comment, so as to increase openness of discussion (from this, we expect Dr. Douste-Blazy not to be invited back, unless the leak was prearranged). Anyway, the big revelation was that the editors of both The Lancet and the NEJM (yep, probably prearranged) had bemoaned the huge pressure placed upon them by Big Pharma, with The Lancet's Dr. Horton going as far as to state that: "If this continues, we are not going to be able to publish any more clinical research data because pharmaceutical companies are so financially powerful; they are able to pressure us to accept papers that are apparently methodologically perfect, but their conclusion is what pharmaceutical companies want" (hardly new, granted)
I'm not sure how sympathetic I can get, given that Dr. Horton had just insisted much the opposite in a public tweet barely a week before that, and it has to be said that the circumstantial evidence is suggesting business as usual for Big Pharma here. The incentives are very clear here, with Remdesivir likely to cost orders of magnitude more than HCQ, before mentioning a supposed correlation of close to one between funding received from Gilead by physicians, and their public opinions expressed against HCQ. Raoult probably isn't going to win many establishment friends with that paper, nor for his digging into why data favourable to HCQ was somehow elided between preprint and publication (not that he likely cares)
Personally, I expect this to be yet so much song and dance, once again; it's not like these elite journals are gonna stop publishing shoddy papers espousing whatever expensive shitty drug Big Daddy Pharma wants, and it's not like the WHO isn't going to suddenly drop their supposed double-blind RCT standards when the leash is yanked. If it's any consolation, twenty-six U.S. states are suing pharma firms for price-fixing of generic drugs, but I ain't holding out much hope of anything but a damp squib of a tame settlement on that either.
Sadly, academic tribalism and fraud hardly seems limited to medicine, with a Purdue professor sounding out on potential organized fraud in ACM and IEEE computer science conferences lately. The mechanism is pretty straightforward: allegedly, a few dozen authors would collude via private chat group, to arrange for their submitted papers to be assigned to fellow conspirators for peer-review. Obviously, these papers would be scored high, outsiders scored low, and all this isn't even that hard to justify even under scrutiny. It is times like this, when I wonder whether I should just retire and take up farming.
All Solutions Matter
Just to clarify again, for all the space I've given HCQ on this blog, I don't actually have that much of a dog in this fight - I'm open to anything that can be shown to work (robot overseers in dorms gave a slight pause, though). The Germans have evidently scrounged up evidence for face masks, and the Japanese are designing cooler and more comfortable ones, excellent! Ivermectin has been getting some good press, as have Antabuse, Canakinumab, Tocilizumab and possibly a host of other existing drugs, more power to them; however, it should be noted that many of these aren't exactly affordable, and let's be honest, a 99% reliable cure at US$100/dose is no cure at all, to the vast majority of the world's population. I hope this explains why I remain rooting for something simple and cheap, even if it's only 50%, heck, 20%, effective.
It goes without saying that a true vaccine would be best of all, but a realistic view would be that no coronavirus vaccine has ever been developed - so why the sudden confidence? Somehow, you have players such as Moderna and Oxford seemingly ready to pump out billions of doses by the end of the year, a timeline I believe is quite unprecedented in vaccine development, if economically tantalizing. Various highly-placed politicians and doctors somehow appear all for it, despite that, moreover preemptively warning that they "shouldn't force drug companies to lower the costs of Covid-19 vaccines and treatments but should encourage fair pricing". Honestly, I'm pinning my last hopes on the virus dying out by itself now.
Next: Of Logic, Looting, Twitter & Disinformation (Part 2.75)
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