[bb88]

Journalists? What? It's written by a doctor and medical students.

Authors: John Havlik, Pranam Dey, and Howard P. Forman

Bios: John Havlik and Pranam Dey are medical students at Yale University. Dr. Howard P. Forman (@thehowie) is a professor of public health policy, management, economics and radiology at Yale.

[OrvalWintermute]

Actually, he is acting as a journalist, and operating out of his specialty (Radiology), and is not clinical with Covid patients.

So, as far he goes, the most he does is sees scans of PTs, or diagnose the damage, through radiological means. Radiologists diagnose, they don't treat Covid.

Internal Medicine (less severe) & Infectious Disease (more severe) specialties treat Covid patients, supported by pulmonologists, hematologists, and the other clinical specialties as problems arise (vascular, cardiologists, etc).

[bb88]

FTFA:

> Dr. Howard P. Forman (@thehowie) is a professor of public health policy, management, economics and radiology at Yale.

I think you failed to see the "professor of public health policy" in his title. I would expect a professor of public health policy to understand how to read results of studies and then translate them to public health policies.

[OrvalWintermute]

> I think you failed to see the "professor of public health policy" in his title.

No, I did not. Public Health Policy and an MBA are non-clinical.

Clinical Doctors that are actively treating Covid19 patients, that are actively using what will be Standard of Care using antivirals, anti-inflammatories, anticoagulants, steroids, ACE2 inhibitors, and other drugs, using well-known medical therapies for sick patients are the doctors that I want to hear from around treatment A, or treatment B. These are the doctors with the experience and the know-ho for these severe diseases.

Again, as a radiologist, or hospital mgmt, the fine doctor is not a clinical doctor actively performing these treatments with these drugs and immunotherapies. Radiologists diagnose.

This is the domain of an Infectious Diseases specialty in severe cases, and an Internist in less severe cases, with the active support of the associated other specialties (cardio/pulmonologists/vascular/etc for all the involved body parts for which there are specific specialties acutely impacted by covid).

[bb88]

> Public Health Policy and an MBA are non-clinical.

What does that have to do with reading and understanding studies? If you're treating patients, sure. But there are doctors that do research -- particularly those in pharma -- and in public policy.

I'm not sure why you want to continue to beat this dead dog of an argument.

[OrvalWintermute]

> dead dog of an argument.

This is not a dead argument. It is an example of specialists in a particular field that are the height of expertise having the best say about the pros and cons of specific medical interventions.

A younger version of myself, when I wanted to learn how to cook, realized that I needed the proper tools with which to prepare ingredients. Being uninformed and ignorant, I was bombarded with reviews of knives written by marketing folks. I did not trust their judgment because they were intent on selling me something, regardless of whether or not it was best for me with the cooking style I would adopt. Instead, I went and talked with two friends having extensive training in the culinary arts and we discussed the pros and cons of various cutlery. One of my friends had a great deal of experience with many makes and models, and could provide a wisdom about product selections. Likewise, this conversation.

The fine doctor/professor, and his 2 juniors have not actually recounted much of the medical literature on COVID 19 treatments except ones that prove their point. In doing so, they have done us a disservice by pushing a discussion in one direction, without adequately informing us of other perspectives that are more expert than they. Why are they doing this? I don't know. But, I do know of COVID treatment protocols and what they contain. There is a specific category of drugs within those protocols called antivirals. It contains a number of different antivirals, which is not really important which one (they have specific pros and cons, different mechanisms of action and some are oral, and some are IV), but the overall dismissal of what will shortly be Standard of Care for Covid19 treatment includes antivirals.

[bb88]

It is a dead dog of an argument. We have vaccines now, which are proven to save lives.

> The fine doctor/professor, and his 2 juniors have not actually recounted much of the medical literature on COVID 19 treatments except ones that prove their point.

Or maybe they have and refuse to believe everything written on paper should be taken as fact?

The lead author has a twitter account, I'm sure you can reach out to him to figure out if he is in fact qualified to make a claim. Let me know what you find out.

[mikedilger]

Thanks for that correction. However they are functioning like journalists here. Notice all of the judgemental, ideological, political one-sided narrative. They fail to apply Hanlon's razor as they claim at the end "[they] know exactly what they are doing." It's paranoid talk. The case for/against ivermectin is very complex and this short diatribe is not helping anyone.

They also clearly are Americans who seem to think this is an American issue. Ivermectin use for COVID-19 is worldwide and isn't aconsequence of "rejecting American Institutions" but was a desperate attempt by caregivers to keep their patients alive. They think they are seeing a pattern - that it works. But humans are easily fooled and see patterns everywhere, so we need better data. In the meantime, those doctors will continue to use ivermectin, and an upcoming Oxford study will get us some better data.

Might I also add that the evidence in support of Remdesivir is much much weaker than the evidence in support of Ivermectin, that the WHO recommends against Remdesivir, and yet in America it's widely used and nobody is bitching about it. Hypocrisy.

[bb88]

No, I disagree. They're functioning like doctors. There is not, nor should be, a political side to science. Facts are facts, and numbers are numbers. And false cures give false hope to the afflicted -- it's no different than snake oil.

In fact their argument is that it's too early to know so going in front of congress and the media is irresponsible.

Hydroxychloroquine, too, showed promise in the early studies. When it became clear it wasn't efficacious, the media and politicians had already grabbed hold informing millions of americans that it was a cure when it in fact was not.

The EUA for remedesivir and EUA revocation of hydroxychloroquine are here. They seem to be self explanatory about why the FDA took the action they did.

https://www.fda.gov/media/137564/download https://www.fda.gov/media/138945/download

[OrvalWintermute]

> Hydroxychloroquine, too, showed promise in the early studies. When it became clear it wasn't efficacious, the media and politicians had already grabbed hold informing millions of americans that it was a cure when it in fact was not.

I think you are mischaracterizing what the research has actually shown.

Similar to HIV/AIDS, the most current clinical research on the field shows to treat it with a cocktail of drugs

E.g.

Antivirals

Immunomodulators

anti-senescent cells

Anticoagulants

ACE2 inhibitors

And a long list of other ones that singularly have some efficacy, but as a large cocktail together dramatically improve patient outcomes.

[bb88]

> I think you are mischaracterizing what the research has actually shown.

Oh no. Look at the early data on HCQ on https://c19early.com/. Results were showing around 66-70% reduction in death with a high confidence interval.

Then look at both the revocation of the EUA from the FDA on HCQ, and look at the NIH study.

FDA: https://www.fda.gov/media/138945/download NIH: https://www.nih.gov/news-events/news-releases/hydroxychloroq...

[OrvalWintermute]

Standard of Care is moving towards a multi-drug cocktail NOT a singular drug.

One of those drugs happens to be one mentioned in TFA.

We should not remove whole classes of drugs such as antivirals from the treatment regimen just because some political figure mentioned A, B or C.

Leave the treatment plan for which antiviral with different effects (of which there are many) to the ID Doc and Internists.

[bb88]

If you believe in evidence based medicine, which apparently you do not, there is no evidence.

Studies which use HCQ are fine -- because they're providing evidence.

What we do have evidence for are vaccinations.