Dr. Fauci is over rated.

[BLA + 1,666]

Great Scientist .  Served four Presidents.

But did not want to even talk about Hydroxychloroquine + Zpak therapy until the FDA can complete a 2000 person randomized study that would take till the end of summer to complete. 

We know the safety profile of HCQ.  It can and is being prescribed off label now.  All of Europe and Asia are starting use now.  FDA has even approved safe for pregnant women.  

How many time in the last week have you heard. " I have a great deal of respect for Dr Fauci but  .   .   .   .   . "

Edited March 27, 2020 by BLA

[James Regan + 1,776]

I think he would like to say a lot more but is being censored or he knows whats coming if he does say too much. He is apparently the man when it comes to Epidemics, wouldn't know why you wouldn't want to listen to him, I suppose it all depends on what your end game is.

Is this Z Pack a prophylactic based medicine? Working in West Africa Im sure many of you have taken anti malaria meds, not good with bad side affects, but better than catching CV19 I would imagine.

[BLA + 1,666]

2 hours ago, James Regan said:

I think he would like to say a lot more but is being censored or he knows whats coming if he does say too much. He is apparently the man when it comes to Epidemics, wouldn't know why you wouldn't want to listen to him, I suppose it all depends on what your end game is.

Is this Z Pack a prophylactic based medicine? Working in West Africa Im sure many of you have taken anti malaria meds, not good with bad side affects, but better than catching CV19 I would imagine.

Fauci does say what he wants. He goes on all the news programs.  

My, and many other's problem is he has no sense of urgency. The highly respected French viral PhD that ran the very successful trial with HCQ said it's immoral and unethical to wait to administer the therapy.

Fauci has a problem. . . .  it wasn't his idea.  

I do have a great deal of respect for Dr. Fauci. .   .   .   but

You realize that Fauci said in January the United States does not have to worry about coronavirus.  He also stated at one point the virus transmits by contact only, not airborne.  This was repeated by state Health Commissioners ( including mine) around the country.

I realize China withheld (still is withholding ) key data.  But how can one make a blanket claim like that based on no facts, no data. 

PS the Zpak is an antibiotic that treats or limits the development of the pneumonia , the ultimate killer 

Edited March 27, 2020 by BLA

[Gerry Maddoux + 3,627]

7 minutes ago, BLA said:

Fauci has a problem. . . .  it wasn't his idea.  

That's not it. Fauci grew up with a system that ignored anecdotal evidence. All those guys are sticklers for efficacy trials, as well as side effects that emerge from a trial like that. 

I'm with you, though. If I'm sick with Covid, give me some stuff!

[BLA + 1,666]

7 hours ago, Gerry Maddoux said:

That's not it. Fauci grew up with a system that ignored anecdotal evidence. All those guys are sticklers for efficacy trials, as well as side effects that emerge from a trial like that. 

I'm with you, though. If I'm sick with Covid, give me some stuff!

Good point.  

I stand corrected.

Learned bias against anecdotal data the reason. 

Edited March 27, 2020 by BLA

[Ward Smith + 6,615]

There's some interesting articles about double blind studies and why they came about. I'll see if things slow down here enough to dig one up. As I recall, doctors were doing some kind of ingested gold treatment (maybe for tuberculosis?) and it was doing more harm than good. However, the placebo effect was quite strong so the FDA after its inception has happily murdered thousands of people "in the name of science" by giving them sugar pills instead of life saving drugs. Doctors can be very cold blooded about people dying. We might see it once in a lifetime, if ever, but doctors can see it every day, so they just stop caring. 

[Yoshiro Kamamura + 274]

Hydroxychloroquine does nothing against COVID-19. 

[Gerry Maddoux + 3,627]

16 minutes ago, Ward Smith said:

Doctors can be very cold blooded about people dying. We might see it once in a lifetime, if ever, but doctors can see it every day, so they just stop caring. 

Really? Strange, I was a cardiologist in the thick of things for over three decades and never saw this. I saw some doctors gut-check a lot of times, and I saw some tough guys crying like babies in the changing room, but I must say, I never once came across a doctor who simply didn't care. Jaded? All the time. Caring? Nope. I'm sure there are those; I just never came across one.

[Ward Smith + 6,615]

18 minutes ago, Gerry Maddoux said:

Really? Strange, I was a cardiologist in the thick of things for over three decades and never saw this. I saw some doctors gut-check a lot of times, and I saw some tough guys crying like babies in the changing room, but I must say, I never once came across a doctor who simply didn't care. Jaded? All the time. Caring? Nope. I'm sure there are those; I just never came across one.

One of my best friends is an ER physician. He actually switched hospital groups to get away from a colleague like that. My other good friend and neighbor is also a cardiologist. He builds up personal relationships with his patients much more than an ER doctor would. He too gets broken up a bit when he "loses" one. 

How would you like to be part of a double blind trial with a heart patient who's clearly getting worse and you know good and well his "treatment" is a placebo? What if that patient were a friend? This is what Fauci wants. Huge blind trials, and if people die? Science. 

[Enthalpic + 1,496]

2 minutes ago, Ward Smith said:

One of my best friends is an ER physician. He actually switched hospital groups to get away from a colleague like that. My other good friend and neighbor is also a cardiologist. He builds up personal relationships with his patients much more than an ER doctor would. He too gets broken up a bit when he "loses" one. 

How would you like to be part of a double blind trial with a heart patient who's clearly getting worse and you know good and well his "treatment" is a placebo? What if that patient were a friend? This is what Fauci wants. Huge blind trials, and if people die? Science. 

The researches are also blind to who is getting the placebo.

Science has a long history of a dark side...

Edited March 27, 2020 by Enthalpic

[Enthalpic + 1,496]

Often the placebo groups are smaller, or they are comparing the new drug against "the current standard of care" so they may not be getting placebo but some other medicine.

If early trials are overwhelmingly successful you can probably get approval for "compassionate use" for the rest.

Edited March 27, 2020 by Enthalpic

[Ward Smith + 6,615]

3 minutes ago, Enthalpic said:

Often the placebo groups are smaller, or they are comparing the new drug against "the current standard of care" so they may not be getting placebo but some other medicine.

If early trials are overwhelmingly successful you can probably get approval for "compassionate use" for the rest.

What, specifically, it's the "standard of care" for Covid19? Bite a bullet? Aspirin? Ventilator when it's too late? 

[Enthalpic + 1,496]

6 minutes ago, Ward Smith said:

What, specifically, it's the "standard of care" for Covid19? Bite a bullet? Aspirin? Ventilator when it's too late? 

Probably "treat symptomatically" aka patch holes as they fall apart and hope they pull through.

So yeah, probably fever and cough medicines, oxygen, maybe dialysis (doubtful).  Not sure.

 

Edited March 27, 2020 by Enthalpic

[Ward Smith + 6,615]

1 minute ago, Enthalpic said:

Probably "treat symptomatically" aka patch holes as they fall apart and hope they pull through.

 

While the chloroquine patients are doing jumping jacks in the hall. 

[Gerry Maddoux + 3,627]

58 minutes ago, Ward Smith said:

How would you like to be part of a double blind trial with a heart patient who's clearly getting worse and you know good and well his "treatment" is a placebo? What if that patient were a friend? This is what Fauci wants. Huge blind trials, and if people die? Science. 

I've been involved in a lot of clinical trials through the years. What you just described doesn't happen: the minute the data becomes lop-sided, the person in charge of the trial takes a look to see if something is so good--or bad--that it would be inhumane to continue the trial. 

I fear that Dr. Fauci may be too stodgy for the times, and I agree that it should be left up to physicians to use or not use a previously-approved drug for off-label use, such as emergency use of Hydroxychloroquine/Zithromax for Covid-19, or even Ampligen (an antibody cocktail made by AIM, a drug that worked in animals with SARS), or even for Remsvirid, a drug that Regeneron and Giliad developed for HIV. 

There is a guy named Bedford, who is running a phylogenetic tree on this virus in a thing called NextStrain. He is mapping out the genome of mutation and a whole slew of drugs that have potential to interfere with different operations of the virus are being looked at. It is not as though this search for treatment is happening in a vacuum. All the pharmaceutical houses are scrambling.  

Already, just with the talk of "amazing" efficacy of Hydroxychloroquine/Zithromax, there is a total shortage of both . . . for clinically proven conditions. The combo may or may not work (I don't personally see how they would but maybe they do). Doctors on the front lines in Texas and Oklahoma are known to be sequestering these things for their own use--and for their family's use. People are scared! If we don't run some sort of parallel studies, we'll have a mess. I personally used a drug for a whole decade, thinking along with everyone else that it dramatically improved heart failure. The initial clinical trial had been interrupted and the seal was broken--it looked inhumane to withhold the drug from patients. And then the numbers began folding upon themselves. When a better, larger, blinded study was finally performed again, alas, there was no difference between that drug and . . . nothing whatsoever. That was one of the darkest days of my career. So you can see, this cuts both ways. We probably didn't hurt anybody with our endeavors, but we built up hope for nothing, and we spent an awful lot of money doing it. 

Dr. Fauci is doing just fine. Right now, he is about our only reliable face on the TV circuit. He has enjoyed an unblemished reputation. He is devoted to his job. He is pushing himself mercilessly. He always gets a plethora of opinions from the brightest people in the room. He takes the good ones. If we fail in this battle, it will be in spite of Dr. Fauci, not because of him.

[Gerry Maddoux + 3,627]

57 minutes ago, Ward Smith said:

While the chloroquine patients are doing jumping jacks in the hall. 

Do you know this? Great improvement? 

I don't. I've heard accounts, but then I've heard contrary accounts. 

If it is true, it must be filtering out into the broader medical community. 

And if it's true, then the president should immediately enact War Powers for all pharmaceutical factories to suspend everything else and produce these two very easy to manufacture items. 

[Ward Smith + 6,615]

30 minutes ago, Gerry Maddoux said:

Do you know this? Great improvement? 

I don't. I've heard accounts, but then I've heard contrary accounts. 

If it is true, it must be filtering out into the broader medical community. 

And if it's true, then the president should immediately enact War Powers for all pharmaceutical factories to suspend everything else and produce these two very easy to manufacture items. 

Only what I've read of course. The shortages are exactly what you alluded to above, in Nevada the governor stepped in to halt doctors from taking all the pharmacy supplies for themselves and family. Like toilet paper, there's massive hoarding going on. I'm afraid when XYZ Chem supplier starts getting orders that are too large to fill properly, there will be shortcuts and mistakes made. Poison might be going out because of that, exactly what the FDA should be stopping. However, hundreds of pages of regulations doesn't truly solve things either. 

Meanwhile I don't trust either entity. They've fumbled every ball they've been handed. They're geared for only two speeds, glacial and reverse. 

[Gerry Maddoux + 3,627]

Okay, here's anecdotal: I just called one of the nurses who worked with me closely for years. She is the nursing supervisor for a 1250 bed hospital. Amongst the patients they have are two thirty-something men who were previously healthy and nonsmokers, a forty-something, and a patient in his fifties. All are on ventilators. All are receiving the kitchen sink: chloroquine and Zithromax, etc. Nothing is working. Nothing. 

Now, if one extrapolates from that, Plaquenil and Z-Pack are losers. We're done. No good. 

But what if these are outliers for some reason? What if, when you run the same experiment on a thousand people from all different backgrounds, different geographic situations, different co-morbid health problems, the combo worked to the tune of 75%?

I rest my case. 

[BLA + 1,666]

8 hours ago, Gerry Maddoux said:

Okay, here's anecdotal: I just called one of the nurses who worked with me closely for years. She is the nursing supervisor for a 1250 bed hospital. Amongst the patients they have are two thirty-something men who were previously healthy and nonsmokers, a forty-something, and a patient in his fifties. All are on ventilators. All are receiving the kitchen sink: chloroquine and Zithromax, etc. Nothing is working. Nothing. 

Now, if one extrapolates from that, Plaquenil and Z-Pack are losers. We're done. No good. 

But what if these are outliers for some reason? What if, when you run the same experiment on a thousand people from all different backgrounds, different geographic situations, different co-morbid health problems, the combo worked to the tune of 75%?

I rest my case. 

A couple of points

Supposedly if you are to the point of needing a ventilator the efficacy drops substantially. Need to administer early on after infection.

The doctor whom managed the French study released some "results" because he felt it was that important.  A full report with details of the trial as in patient conditions, dosage, success vs timing of treatment introduction, etc is expected next week.

In standard FDA clinical trials Phase 1 and Phase 2 are carried out to determine safety/toxicity.  Of course they will monitor efficacy of the drug during Phase two.  Phase 3 is for efficacy and has a larger population, like Fauci wanted 2000 patients.

We know the safety profile.  The FDA has approved for use by pregnant women.  What more do you need. Hydroxychloroquine better than chloroquine as to fewer side effects. 

There is hoarding by individuals in the U.S.  There is also hoarding by countries that mfg the HCQ ie Germany, India, China.  Some have banned it's export.  

I don't know how quickly a U.S. manufacturing plant can be certified/licensed to mfg the product.  

 

Edited March 28, 2020 by BLA

[surrept33 + 609]

There seems to be many valid reasons why the medical research community has criticisms of the french study and is calling for a randomized study (which are taking place), I'll just link a Twitter thread since he can explain it better than I can:

https://twitter.com/GaetanBurgio/status/1241201751916568576

 

Edited March 27, 2020 by surrept33

[ronwagn + 6,290]

4 hours ago, Ward Smith said:

There's some interesting articles about double blind studies and why they came about. I'll see if things slow down here enough to dig one up. As I recall, doctors were doing some kind of ingested gold treatment (maybe for tuberculosis?) and it was doing more harm than good. However, the placebo effect was quite strong so the FDA after its inception has happily murdered thousands of people "in the name of science" by giving them sugar pills instead of life saving drugs. Doctors can be very cold blooded about people dying. We might see it once in a lifetime, if ever, but doctors can see it every day, so they just stop caring. 

There is some truth to that. 

[BLA + 1,666]

3 hours ago, Gerry Maddoux said:

Okay, here's anecdotal: I just called one of the nurses who worked with me closely for years. She is the nursing supervisor for a 1250 bed hospital. Amongst the patients they have are two thirty-something men who were previously healthy and nonsmokers, a forty-something, and a patient in his fifties. All are on ventilators. All are receiving the kitchen sink: chloroquine and Zithromax, etc. Nothing is working. Nothing. 

Now, if one extrapolates from that, Plaquenil and Z-Pack are losers. We're done. No good. 

But what if these are outliers for some reason? What if, when you run the same experiment on a thousand people from all different backgrounds, different geographic situations, different co-morbid health problems, the combo worked to the tune of 75%?

I rest my case. 

Hydroxychloroquine (Trump), $15 per treatment, while others (Fauci) want to try out Remdesivir, $1000 per treatment. He got his wish. 

Fauci wants to mfg stock pile of Remdesivir, even though it is a long shot. 

Ever since Bush passed the Medicare part D pharmaceutical lobbyist has become a leading profession in DC.

Understand , Fauci has been entrenched in the DC establishment for years.  He actual is a self proclaimed partisan and vocal fan of Hillary.  That doesn't make him a bad person.It could affect how he interacts or works with Trump.  

I have a great deal of respect for Dr.Fauci . . . . .  but

 

Edited March 27, 2020 by BLA

[Enthalpic + 1,496]

11 minutes ago, BLA said:

Hydroxychloroquine (Trump), $15 per treatment, while others (Fauci) want to try out Remdesivir, $1000 per treatment.

Fauci wants to mfg stock pile of Remdesivir, even though it is a long shot. 

Ever since Bush passed the Medicare part D pharmaceutical lobbyist has become a leading profession in DC.

Understand , Fauci has been entrenched in the DC establishment for years.  He actual is a self proclaimed partisan and vocal fan of Hillary.  That doesn't make him a bad person.It could affect how he interacts or works with Trump.  

I have a great deal of respect for Dr.Fauci . . . . .  but

 

Trump isn't a Dr - his main push for the HCQ is hope and to get people back to work ($).

 

Try them both and look at evidence.

 

Edited March 27, 2020 by Enthalpic

[BLA + 1,666]

1 hour ago, Enthalpic said:

Trump isn't a Dr - his main push for the HCQ is hope and to get people back to work ($).

 

Try them both and look at evidence.

 

Agree try them all. 

Many Dr's have prescribed Hydroxychloroquine and attested to its effectiveness.  Fauci has downplayed HCQ as anecdotal and promoted Regeneron and Gilead's  remdesivir which is also without any trial data as a therapy for coronovirus.

All I'm saying is just because HCQ has been around for over 60 years does not automatically eliminate it as a solution. 

A lab at Boston University Medical School has been set up to test over 40 possible Covid therapies in vitro. 

Yes ! Test them all. 

Edited March 27, 2020 by BLA

[Gerry Maddoux + 3,627]

7 minutes ago, BLA said:

Agree try them all.  Many Dr's have prescribed Hydroxychloroquine.  Fauci has downplayed HCQ as anecdotal and promoted remdesivir which is also without any trial data.

Well, it's not quite that bad. Giliad developed Remdesivir for Ebola and Marburg--two of the meanest, highest mortality viruses in the world. It worked. Since these are rare diseases, Giliad received an "orphan" status designation for the drug, which means that no one can produce a copycat for seven years. 

They tested the drug against several other single-stranded RNA viruses, especially those causing severe airways disease: Ripah, Respiratory Syncytial Virus, and finally coronavirus. So Remdesivir has been a) well shown to have antiviral activity against these single-stranded RNA viruses and b) seems relatively safe. 

They've actually given it to some patients with this disease. Giliad, to their credit, dropped the orphan status, which allows any drug company to manufacture this drug for a nominal cost. Maybe they did that under pressure but it tells me that they think it may have a place. 

Am I pushing Remdesivir? No, of course not. But it has been subjected to some of the rigorous scrutiny that other drugs have to undergo. 

My hunch is it's going to wind up being the "Big Drug" in treating this virus--simply because it is so close in design to the other viruses out there with proven efficacy. But who knows? HCQ/Z may wind up being the ticket. I just wish they'd start giving us a down to earth update on this on a daily basis. Quite a few doctors have sequestered HCQ/Z--and I don't blame them; they're on the front lines.