Sunday, April 18, 2021

How can they keep slamming hydroxychloroquine? By pretending the overdose HCQ/CQ studies didn't overdose, and meta-analyzing them/ Nature Communications

Just in case people are starting to wake up and realize there are actually effective drug treatments for Covid, it is important to keep banging the drum that says, not only don't the drugs work, but they are dangerous, to boot. And so we have a new meta-analysis designed to do just that.

This is very easy to do.  Here's how:

1. Never admit there was anything wrong with the trials that overdosed patients with hydroxychloroquine or chloroquine.  In fact, these authors called the Recovery and Solidarity trials that gave patients 4 times the normal dose of HCQ at first, "pragmatic." Odd use of verbiage.
2.  Cherry pick a small number of studies from which to perform your meta-analysis, so that the number of subjects in the overdose studies outweighs the number in all the other trials. In this case 67% of all subjects in this meta-analysis (which included about 14 of 233 total trials) had been enrolled in the Recovery and Solidarity overdose trials. Two other overdose studies were included, PATCH and Remap-CAP. (PATCH abruptly ended after only 5 subjects were enrolled, once the other overdose trials were exposed.)
3.  Because the overdose studies (except PATCH, in which none of the 5 died) had a higher proportion of deaths in the hydroxychloroquine arms than in the placebo arms, and provided more than two thirds of the subjects for this meta-analysis, the authors of the meta-analysis were able to conclude that using HCQ is associated with higher death rates than using nothing at all.  
4.  Incredible that the toxic doses used in 4 of the trials selected are whitewashed by calling them "relatively high doses" and never linking these doses to the increased death rates.
5.  Another odd thing is that investigators from the included trials, whose data were used in this study, are listed as coauthors.  There are 94 coauthors, all of whom signed off on the final paper (i.e., the overdose investigators had the opportunity to craft the language of this paper to cover their butts regarding their overdose trials).
6.  Many of these investigators have financial interests in products and/or companies making new products for which hydroxychloroquine would be a cheap competitor.

Here is the new paper.

Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trialsvolume 12, Article number: 2349 (2021)
"Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20)..."


Anonymous said...

Why do they keep slamming HCQ, and Ivermectin for that matter? It all makes sense, if you ask the right question. Here is a sample question: How do you get the entire planet to take an experimental vaccine? Answer: You scare the public to death, force them into long-term masking and lockdowns, and discredit anyone trying to provide early, outpatient treatment (HCQ or Ivermectin).

Another sample question: Why must we rely solely on vaccination to control this pandemic?

Dr Chris King said...

"The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20)."

Haha! That's hilarious. "All-cause mortality" includes a meteorite falling on the head of a study participant. And an odds ratio of 1.11 translates to an 11% increase in risk. However, the 95% confidence interval says (with 95% confidence) that the actual increase in risk in the broader population represented by the study is likely to be as low as 2% (and, to be fair, as high as 20%).

These are not compelling numbers, especially for a meta-analysis in which participating studies were deliberately selected for their "relatively high" doses.

The bottom line, then, is this: don't take too much of it; but even if you do, there's about a 90% chance that you'll be alright (just keep an eye out for meteorites).

Meryl Nass, M.D. said...

The game that is being played here is to acknowledge that there were more deaths, which are needed in order to blacken the hydroxychloroquine treatment.

But there can't be too many more deaths or someone might start looking at the trial protocol, and worse yet, charge the investigators with manslaughter.

So the PIs are doing their best to point the finger at other causes of death--no, it wasn't really the HCQ, look at the confidence interval, these deaths could be due to chance.

It is a delicate dance they do. But it won't work.