The review of evidence by Harvey Risch in his article is biased and not the fair appraisal that one might expect from a member of the editorial board of the American Journal of Epidemiology.
Peer-review process must be released.
The article must be retracted.
academic.oup.com/aje/article/do…
(spoiler : because the promotors of HCQ said that it’s efficient in hospitalized patients)
Not HCQ+AZ.
Therefore, criticizing the fact that other researchers and agencies further tested the efficacy of HCQ and not only of HCQ+AZ doesn’t seem pertinent.
Didier Raoult said that "chinese researches have proven the efficacy of HCQ".
This was a false statement.
jstage.jst.go.jp/article/bst/ad…
HCQ alone.
Not HCQ+AZ.
In this trial, he enrolled patients who developped Covid-19 pneumonia.
The second method accounts for treatment exposure only before mechanical ventilation.
The only author that has a true affiliation is Pierre Levy, from iPLESP (Institut Pierre-Louis de Santé Publique, which is a French institute of Public Health).
End of the statement by iPLESP.
(spoiler : a bunch of most biased studies on HCQ ever)
Let’s have a look at these studies and how Harvey Risch comments on them.
Harvey Risch claims that this study shows efficacy of HCQ+AZ.
He claims to have "reanalysed the raw study data" and found the same conclusion.
He rejects the criticism about the "small study size", saying that criticism on size matters only when no evidence is found.
"Lack of randomization" and "small study size" were not the only valid criticism against Gautret et al.
Other valid criticisms were :
At the time Harvey Risch wrote his paper, this statement had not been updated.
It's disturbing that Harvey Risch didn't see the big methodology problems of the article by Gautret et al.
I must object that this study was led on hospitalized patients, and included patients who were not given medication early.
It was first published on April 20th on the website of IHU Mediterranee Infection, then on May 5th in Travel Medicine and Infectious Disease.
But one criticism is sufficient to exclude this study of the list of studies showing efficacy of HCQ+AZ : this study has no control group.
A study with no control group can’t conclude to efficacy.
I wonder how Harvey Risch can ignore that.
The commentary by Harvey Risch relies on a 2 pages statement by Dr Zelenko on Google Doc.
How can Harvey Risch comment on a study which is not even published?
This study was initially touted by Didier Raoult
And that's all.
No data.
No article.
No pre-print.
Nothing.
(spoiler : no)
It has not been proven in hospitalized patients.
It has not been proven in outpatients.
It has not been proven in early / mid / late Covid-19.
To answer this question, one should take into account that the FDA has published an article showing that HCQ doses that have been found active in vitro cannot be reached in vivo. ncbi.nlm.nih.gov/pmc/articles/P…
(spoiler : no, because it should not be prescribed and patients should not take it)
a. Every drug have side effects.
d. Clinical trials are bad to show rare side effects. Trying to conclude on rare side effects on the basis of small clinical studies is stupid.
One of the basic principles of bioethics is « primum non nocere ». This principle implies that drugs who have not shown benefit should not be prescribed to patients.
(spoiler : with even more bullshit)
I will focus on his response to @DgCostagliola and @nathanpsmad :
a. Cox regression was not the analysis planned in the protocol of the study, and Peffer-Smadja and Costagliola performed the same statistical tests as the authors of Gautret et al.
Is that « many » ?
How many patients were « very mildly symptomatic » ? We don’t know, because Gautret et al. does not mention that. How does Harvey Risch know ?
Peffer-Smadja and Costagliola are right. As I show above, « Zelenko study », « Sao Paulo study » and the « small study ongoing in a long-term care facility in Long Island, NY » are unpublished.
For instance, is Zelenko study a clinical trial ? Where has it been registered ? I can’t find it in clinical trials register database.
He cites for example the study by Lagier et al. (from Didier Raoult’s team).
Because if they did not treat some patients, it’s obviously because they were at higher risks or had contra-indication to treatment.
In the control group, 39.3% were hospitalized.
In the treated group, 13.8% were hospitalized.
When the patients worsened, they could be hospitalized in conventional units.
Of course, this retrospective study is a total mess.
As I described above, ISAC (the society editing IJAA) and Elsevier published a joint statement to criticize the article by Gautret et al.
Ref 14 cited by Harvey Risch is the response from Didier Raoult to Elsevier.
It's easily comprehensible : this response is ridiculous.
This shows that there is no distance at all in the appraisal by Harvey Risch : he reads something by Raoult and he cites it, and that’s all.
Furthermore, this « meta-analysis » has been widely mocked on twitter... because it is not a meta-analysis
It's not dishonorable to retract a bad article.
This review by Harvey Risch is a bad article.
It should not have been published in a journal of epidemiology.
It is a matter of credibility for @AmJEpi.
It is a matter of « is this critical appraisal by Harvey Risch honnest and worth publishing in a world leading journal of epidemiology ? ».
And it’s definitely not.
END. ⏹️