This is something substantive, largely apolitical, that can be discussed. I will go over some points at the bottom of the post. My purpose in creating this thread, though, isn't for me to do all the work...I hope that people can come to the thread and post things and that other people with expertise can comment.
SLD said:
Who is this Dr. Risch though? He claims to be a Yale epidemiologist. Is that true?
Yes, it's true. He is a Yale cancer epidemiologist. There is a statement made by the Yale School of Public Health
here. Note the pointing to recent studies the FDA cites...
Dr. Harvey Risch is a distinguished cancer epidemiologist who has opined on the topic of hydroxychloroquine (HCQ) and COVID-19 out-patient therapy. He has written a review article in the American Journal of Epidemiology that cites evidence that he believes supports HCQ use for out-patient infection with SARS-CoV-2. Studies that indicate no effect or harmful effects, Dr. Risch believes, enrolled patients too sick to benefit from HCQ.
Yale-affiliated physicians used HCQ early in the response to COVID-19, but it is only used rarely at present due to evidence that it is ineffective and potentially risky. The Food and Drug Administration of the U.S. Public Health Service issued the following statement (in part):
June 15, 2020 Update: Based on ongoing analysis and emerging scientific data, FDA has revoked the emergency use authorization (EUA) to use hydroxychloroquine and chloroquine to treat COVID-19 in certain hospitalized patients when a clinical trial is unavailable or participation is not feasible. We made this determination based on recent results from a large, randomized clinical trial in hospitalized patients that found these medicines showed no benefit for decreasing the likelihood of death or speeding recovery. This outcome was consistent with other new data, including those showing the suggested dosing for these medicines are unlikely to kill or inhibit the virus that causes COVID-19. As a result, we determined that the legal criteria for the EUA are no longer met.
As Dean of the Yale School of Public Health where Dr. Risch is employed, I have championed maintaining open academic discourse, including what some may view as unpopular voices. The tradition of academia is that faculty may do research, interpret their work, and disseminate their findings. If persons disagree with Dr. Risch’s review of the literature, it would be advisable to disseminate the alternative scientific interpretations, perhaps through letters or other publications with alternative viewpoints to the American Journal of Epidemiology, Newsweek, or other outlets. My role as Dean is not to suppress the work of the faculty, but rather, to support the academic freedom of our faculty, whether it is in the mainstream of thinking or is contrarian.
- Sten H. Vermund, MD, PhD
Dean and Anna M.R. Lauder Professor of Public Health; Professor of Pediatrics, Yale School of Medicine
SLD said:
He says that numerous studies back up his claim that it does work if done early enough before the viral load gets too large.
I've taken a cursory look at some study descriptions prior to reading the article. I don't recall seeing any study designs that are comparing drug X over early versus late dosing. I don't recall seeing early/late dosing as a thing at all. I could be wrong. So I believe the doctor is making inferences or even guesses, though I cannot be sure. Can you give evidence from primary sources, i.e. the studies themselves that discuss this?
SLD said:
I don’t think he can be simply dismissed like this demon sex doctor.
I hope this is not a thing that we start doing in the thread. I would like us to discuss the arguments. Both ways are fallacies:
argumentum ad hominem and argument from authority. I'd like us to look at the specific arguments.
As such, here is my rudimentary summary (which I am sure is slightly off but I think will suffice):
- 1. Here are some small studies where it worked (with zinc and an antibiotic);
- 2. Here are some large studies where it was safe;
- 3. In other studies, doctors did it wrong (they gave it too late);
- 4. Adverse events/side effects are due to other factors (lupus and rheumatoid arthritis);
- 5. In some countries, using it is associated with turning around death rates.
1. In science, we want to avoid cherry-picking or unintended consequences from wishful thinking. So, we want to look at all studies, not just a few that support the thing in question. What are the results of all the studies in efficacy? Moreover, why does this thing need zinc and antibiotics, do all anti-virals need these and what are their successes versus the successes of HCQ? That's really the question--how practical and effective is it relative to other options as seen through a vast number of studies, not just some studies?
2. What is the result of all studies where its safety was analyzed? Again, we do not want to only look at successes.
3. What is the primary evidence for this, i.e. statistical analysis of patient records? This seems to be an inference or guess. Where's the data?
4. same as above.
5. He seems to be making an inference at a meta-level based on limited data and without examining the open question of all countries' data, not just the ones he wants to look at.
Who can answer these questions?
[ETA: It would appear that some of this is answered by looking at some of his writing. When he says "early," he seems to actually mean out-patient and when he says "late," in-patient.]
