Before Covid politics:
Ivermectin excites scientists: "help improve global public health by treating a diverse range of diseases, with its unexpected potential as an antibacterial, antiviral and anti-cancer agent being particularly extraordinary.🧵👇 pubmed.ncbi.nlm.nih.gov/28196978/
Before Covid politics:
"Ivermectin has continually proved to be astonishingly safe for human use"
Now most media refer to it as an "unapproved animal de-wormer" & have flooded the public with hundreds of false & exaggerated overdose stories. 🧵👇
Designing valid retrospective reviews is like putting lipstick on a pig. But RCT's have no porcine roots. They start out with racehorse potential, which made it even more sad when the major design flaws in this study rendered this horse lame. Analysis:👇 acpjournals.org/doi/10.7326/M2…
To test whether #HCQ works for #COVID19, subjects must have had proof that they actually had it, not just clinical suspicion. Without this evidence, we can't draw reliable conclusions. But only 1/3 had positive COVID tests. And maybe that's why the following didn't add up:👇
Case fatality rate (CFR) for the placebo group was about 0.5%, but the observed US COVID19 CFR at the time of study enrollment was 5.58%. Could this discrepancy have been in part due to many in the study never having had COVID19 in the first place?👇cebm.net/covid-19/globa…
My Dad's recent #COVID19. Not an academic document-just sharing a human experience of outrage & triumph.
My Dad is almost 90, frail as can be, in a nursing home. I went to visit him 3 months ago & wore a mask before it was fashionable to protect him just in case I had it.
I sent an email to 5 people at the nursing home the next day saying that I was shocked that none of the staff or visitors were wearing PPE. I warned them that the now infamous Seattle nursing home which had massive deaths early on in the #COVID pandemic was a sentinel event.
I warned them that they needed to "act now" to prevent a "major tragedy," but not a single one of the recipients responded to my email, silence. I reached out to my Dad's doctor to discuss the situation. She felt that he was a sitting duck and that prophylaxis was appropriate.
I think the authors put forth a good effort, but there are significant issues with this study, which was intended to evaluate #COVIDー19 post-exposure prophylaxis with #HCQ. My two cents:👇nejm.org/doi/full/10.10…
Planned enrollment threshold was within 3 days of exposure due to the average incubation period of 5.5 days. But then the threshold was changed to 4 days. Cutting it close. One can argue that the study nearly misses its basic premise of being a PEP trial. And then this: 👇
Authors wrote that the "vast majority of the participants" couldn't get diagnostic testing for #Covid. Instead, they looked at symptoms and labeled some cases as "probable," about which they admit, "predictive power of this case definition is unknown." Is this OK?👇
Subconscious biases are ubiquitous and powerful. We all have them, so what are going to do about it? "Confirmation bias—probably the most pervasive and damaging bias of them all—leads us to look for evidence that confirms what we already think." theatlantic.com/magazine/archi…
Physicians are vulnerable to bias just like other humans and it can lead to diagnostic errors. "The culture of medicine has never been one that encourages discussion of physician vulnerability." beckershospitalreview.com/hospital-physi…
This article details how researchers are blind to their own bias but can easily point it out in others, including when it comes to how receiving gifts from pharmaceutical companies affects decision making. cmu.edu/news/stories/a…
This study implies that it's an early treatment study because hospitalized patients were treated within 48 hours of diagnosis. It's a late treatment study, and here's why: 👇
About 2/3 of patients were from N. America. Unlike Asia and Europe, we haven't had access to early #C19 testing & quick turn around times. By the time patients get to the hospital, 5-7 days have typically gone by, results have been taking about 4 days, & add 48 hours to that. 👇
Not a prospective, randomized study. No p-values provided to assess differences between treatment and control groups at baseline, ie "control" group had almost twice as much azithromycin treatment as hcq group, higher CRP, and lower lymphocyte counts. Statistically significant?
These patients were not treated early in their illness, when an antiviral effect would be most helpful. The average duration of symptoms before admission was 7 days and hcq was begun within 48 hours after that, so patients were treated from 7-9 days after symptoms had begun.
Spirochetes had been found in human MS autopsy tissue since the early days of medicine. They called it Spirochaeta Myelophthora. Many researchers have published the same findings. pubmed.ncbi.nlm.nih.gov/13118387/
Lyme bacteria (back then called cystic forms, now called round bodies or persisters) was isolated from spinal fluid of MS patients but not from healthy controls apart from one who had a history of Lyme. pubmed.ncbi.nlm.nih.gov/11787831/