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French group claims malaria drug cures coronavirus

 

A new draft paper from a group of French researchers reports very encouraging results from the malaria drug Hydroxychloroquine, combined with Azithromycin, an antibiotic. 80 coronavirus-positive patients were treated, and all but two of them showed a rapid improvement over a few days.

Unfortunately, the team leader, Didier Raoult, seems to be something of a maverick and doesn’t do science the conventional way.  You might expect a double-blind trial to be done, where neither the patients nor the researchers know who’s getting the treatment and who’s getting the placebo. Or at least you’d expect to have a control group. But here, there was no control whatsoever, so we don’t know whether the recovery of the patients was due to the treatment, or if they would have got better anyway. Only 10 of the 80 patients were in the high-risk over-70 age range.

Another paper by the same team was submitted on March 16, accepted on March 17 and published on March 20.  By a remarkable coincidence, one of the authors of the paper also happens to be the editor of the International Journal of Microbial Agents that published it. This paper did have a control group but the number of patients was very small and numerous questions have been raised about the work on the pubpeer system, by Elisabeth Bik, Nick Brown and others. Despite the speed in getting the paper out, none of the 18 authors of that paper have attempted to address any of the questions that have been sitting at pubpeer for a week.

A particularly damning article about Raoult and his work has been posted by Leonid Schneider at his Forbetterscience blog. In addition to raising some of the pubpeer issues about the March 20 paper, Schneider reports that some of the many papers Raoult has written in the past appear to have photoshopped or duplicated images. Worse than that, it appears that Raoult may have committed the crime of being sceptical of the climate change scare.

Even more unfortunately, the issue has now been hopelessly politicised, since Donald Trump tweeted the March 20th paper. You can therefore with almost 100% accuracy predict someone’s opinion of the validity of Raoult’s work if you know their opinion of Donald Trump, or vice versa. So it’s no surprise that the Guardian is critical of the use of the drugs, trying to claim that it will mean other people who need them won’t get them.

91 thoughts on “French group claims malaria drug cures coronavirus

  1. Paul, the control group in the second study is described:

    “Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point”

    So no randomisation and high probabilty of selection bias.

    Elsewhere, Lover from University of Mass. has further analysed the results
    https://doi.org/10.1101/2020.03.22.20040949

    and concluded

    “The trial of Gautret and colleagues, with consideration of the effect sizes, and p-values from multiple models, does not provide sufficient evidence to support wide-scale rollout of HCQ monotherapy for the treatment of COVID-19; larger randomzied studies should be considered. However, these data do suggest further study of HCQ-AZ combination therapy should be prioritized as rapidly as possible.”

    In this case Trump’s propensity to tout good news without the full facts has already had repercussions – one death with an Arizona man and his wife consuming chloroquine phosphate, and reports of people buying Hydroxychloroquine without prescription or medical advice.

    Also not much discussion of the potential side effects of HCQ – which include psychiatric and cardiac problems. Hence the need for proper RCTs to evaluate the effect size (if any), and weight this against the potential adverse outcomes.

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  2. AFAIAA, HCQ was used extensively in South Korea and China for CV19, and is being used in hospitals throughout the US. It’s hardly something new and it’s been used a long time for malaria prophylaxis, so safety is already well characterized and over such a short period likely to be non-existent. I believe there’s also a study from China showing efficacy, but whether anyone trusts anything that comes out of China at the moment is another matter.

    The couple who took HCQ in Arizona found it in some kind of fish tank additive. It’s possible they OD’d, or that there was some other chemical in there that did the damage. It might help cure CV19, but it can’t cure stupid.

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  3. Mediapart, an independent on-line journal, has published this article in English with an excellent critique of Raoult’s controversial studies.
    https://www.mediapart.fr/en/journal/france/260320/chloroquine-controversial-drug-heart-race-coronavirus-treatment
    They’ve also written about his controversial links with local rightwing politicians – nothing shady, but typical of Marseille v. Paris political rivalry. They accuse him of using the Medpub system to promote his citations by signing more articles than he could possibly contribute to (who doesn’t?) and of empire building on the back of the post-9/11anthrax scare, while acknowledging his scientific reputation.

    They also confirm Escobar’s story of the feud with the head of France’s medical research body and husband of the ex-health minister.

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  4. We live in extraordinary times. The evidence – albeit not rigorously obtained via exhaustive clinical trials – is that this treatment significantly improves life expectancy of severe/critical patients and that it is relatively safe to use over a short period. As such, governments should licence its use on a voluntary basis, allowing patients to ultimately decide if they wish to be given the treatment or not, after having been made aware of the possible risks. Attacking the man on the basis of his character and politicising the issue is NOT going to help. The public deserve the simple facts (available as they are) on the potential efficacy of this treatment, weighed against the possible risks of using it – NOW, not tomorrow, next week, next month. Instead of threatening us with even more harsh limitations upon our freedoms, the government should now be rolling out this treatment on a voluntary basis in the hope of saving lives and easing pressure on the NHS. If they do not, you have to ask yourself where their priorities lie.

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  5. This was a rather rushed post but I thought it was an important issue to put up for discussion.

    PM, when you say ‘the second study’ you mean the second one in the post, the first one they published. I suggest we refer to them as the March 20th and March 27th studies!

    Geoff thanks for the feedback from France. I had heard that he is regarded as a hero by some.

    Dave, indeed it’s not a new idea. There was a Chinese paper published on Feb 4 that showed chloroquine working against the virus in vitro. And the French group cite this paper.

    https://www.nature.com/articles/s41422-020-0282-0?fbclid=IwAR3c5iy9h65X1cnkrL6i6fJcWwi0ygN1LtI67SkcgREM4DyxxAcPauRuf5w

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  6. JAIME

    Attacking the man on the basis of his character and politicising the issue is NOT going to help. The public deserve the simple facts (available as they are) on the potential efficacy of this treatment..

    Exactly. I’ve been following the story on French TV as an ignorant layman, and it’s only because of Paul’s article (and PM’s links) that I bothered to look into the scientific criticisms. On the surface, it looks like the kind of wartime story we all love, of the eccentric boffin versus the mandarins and stuffed shirts of the establishment. And the shirts really do look stuffed, as if they’re hiding something, when they appear on TV.

    The government announced yesterday that they were allowing use of the treatment in serious cases, whereas Raoult recommends it for preventive use in the early stages, which I believe is how it’s been used for malaria and other tropical diseases. The other point that any layman can understand is that it’s part of an exploratory search through dozens of possible existing molecules, in thousands of possible combinations, and that the idea of properly conducted clinical trials in those circumstances is unrealistic. Joe Public has a hunch that the man with a hunch beats the functionary who insists on sticking strictly to the rules. Hunches can be wrong, but they’re actionable straight away.

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  7. There is an FDA approved full blown clinical trial of hydroxychloroquine alone, it plus azithromycin, and chloroquine phosphate alone presently ongoing in New York. We will know results in a few weeks. The drugs were donated by Teva, Bayer, and Sanofi.

    The Az couple overdosed on chloroquine phosphate used as fish tank cleaner. LD50 is > about 2 grams. It is a common problem in Nigeria where people OD on their inexpensive malaria meds by thinking more is better. Typical therapeutic dose is 250mg, 1/8 of the LD50, itself dependent on body weight.

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  8. At present the most reasonable conclusion is that HCQ monotherapy has no convincing evidence, but dual therapy with Azithromycin should be subject to further study and is potentially beneficial. Doctors use whatever they think might work for each patient in the circumstance at the time, so HCQ is being used irrespective of what the literature says. I think doctors in Spain and Italy and France, and soon to be in New York, and everywhere should use whatever they think might save lives. My experience as a doctor in remote Australia we are often questioned by our pharmacists because we sometimes prescribe contrary to what the therapeutic guidelines dictate – the answer is we are treating this patient at this time with this presentation and our clinical judgement is that this is the best option at this time. I always review the literature but if I think a different drug is the best option in the circumstances that is what I will do. Raoult’s approach is problematic because it creates an unrealistic expectation on the basis of obviously flawed research.

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  9. Raoult’s approach is problematic because it creates an unrealistic expectation on the basis of obviously flawed research.

    Aided by deep global anxiety about Covid-19 itself.

    Want the good news or the bad news?

    The good news: a climate sceptic has got the world’s attention in a pretty unprecedented way.

    The bad news? I’ll let the reader work that out for themselves.

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  10. Has anyone asked the Doctors working in the same hospital as the trial study whether they would like to have the drug prescribed for them, based on the evidence they observed?

    Based on statistics so far, being a Doctor in a Coronavirus hospital seems to be the highest risk occupation, and they ought to have some choice.

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  11. New Yorker magazine (they don’t deserve a link) is describing this work as “quackery” – just because it’s been promoted by Trump.

    Raoult says he didn’t do a control because of his Hippocratic oath to look after patients

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  12. Here’s Raoult’s climatosceptic article from 2013
    https://www.lepoint.fr/invites-du-point/didier_raoult/les-predictions-climatiques-sont-absurdes-08-10-2013-1740365_445.php#
    from le Point, which corresponds roughly to the Spectator in the UK. There’s a later one here
    https://www.lepoint.fr/editos-du-point/sebastien-le-fol/le-climat-science-ou-religion-01-11-2014-1877726_1913.php
    but I can’t access it, possibly because one is only allowed one article per day or something.

    His scepticism of mathematical models comes from his work on Ebola. He says: “We can extrapolate from known data that the figures will evolve at the same pace, by deduction, but nothing is less certain…”

    He has a book coming out this week. Reviews should be interesting.

    Reactions to Raoult split on interesting lines. Dany Cohn Bendit (Red Dany of Paris 1968, and ex-head of the Greens in the European parliament) was purple with rage discussing him on TV this evening. A good sign.

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  13. STEWGREEN
    It’s the same article I linked to above, from Asia Times or the Unz review. Such conspiracy theorising has been criticised in today’s “Journal de Dimanche” (sort of Mail on Sunday) by a historian, expert on conspiracy theories, who sort of absolved Raoul, but mud sticks. The Macron-friendly media are getting worried. Both Macron’s parents were doctors, I believe.

    A minority of the medical profession are very rich and influential via directorships of private clinics, etc, and the French are sensitive about their pharmaceutical industry, partly because of a number of scandals and cover ups, and partly because it doesn’t compare with Germany’s or the USA’s. Medical research is apparently very developed I believe, however, thanks to the Insitut Pasteur and others.

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  14. The conspiracy theories are interesting but this doesn’t depend on any.

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  15. On the Wuhan lab ‘conspiracy’ theory. It is a fact that the Wuhan Institute of Virology was culturing in vitro SARS-like bat coronaviruses:

    “Severe acute respiratory syndrome coronavirus (SARS-CoV) is a zoonotic pathogen that caused the 2002-2003 SARS pandemic, which originated in China (1). Since then, genetically diverse SARS-like coronaviruses (SL-CoVs) have been reported in bats in China, Europe, and Africa (2–11), indicating a wide geographic distribution of this group of viruses. However, most bat SL-CoVs have been identified only by sequences and are not fully characterized due to the lack of cultured viruses. Thus, their potential for transmission to and likely pathogenesis in domestic animals and humans remain untested. WIV1 and WIV16 are two recently identified SL-CoV strains with high genomic similarity to human SARS-CoV. These two strains have been successfully cultured in vitro and have been shown to use the same molecule (angiotensin-converting enzyme [ACE2]) for cellular entry as SARS-CoV (2, 10). Recently, another bat SL-CoV strain, SHC014, has been demonstrated to use human ACE2 by the construction of an infectious cDNA clone (12). Furthermore, animal infection experiments indicated that SL-CoV WIV1 and SHC014 could replicate efficiently and caused low pathogenesis in ACE2 transgenic mice (12, 13). The fact that the native bat SL-CoVs could use human ACE2 without any mutations indicates a high risk of interspecies transmission for these and similar coronaviruses that may exist in natural reservoirs.”

    https://jvi.asm.org/content/90/14/6573

    I remain sceptical of studies recently released which purport to demonstrate that Covid-19 cannot have been genetically engineered and is alsmost certainly the result of natural mutations either in a human or animal host, prior to it acquiring human to human pathogenicity.

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  16. According to this article the Raoult protocol has been officially approved in France.

    https://www.trustnodes.com/2020/03/28/debate-ends-over-chloroquine-as-france-officially-sanctions-usage

    Maybe Geoff could confirm if that’s what the French minister said?

    Though I am sceptical of an article claiming in its headline that the debate over chloroquine is over!

    If it’s all true, we should see deaths in France drop sharply over the next few days. Fingers crossed.

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  17. Paul: Are you sure “we should see deaths in France drop sharply over the next few days” if the report is true? There is some kind of lag, presumably. And, as a non-expert, that’s made more complicated for me because chloroquine or hydroxychloroquine has been reported to be effective both in protecting from the virus in the first place (like a vaccine) and, for those infected, and with complications, warding off the dreaded pneumonia and severe lung problems:

    Two days ago the established anti-malaria drug chloroquine phosphate was highlighted by WUWT, yesterday by James Delingpole, today by President Trump (should be easy to find). Big Pharma won’t make any money out of it. That part’s so sad. I hope it goes a long way to provide protection from the virus and relief from the worse aspects of pneumonia-type responses until a true vaccine has been developed.

    That was me ten days ago. (I could have mentioned Elon Musk as well but I didn’t think his climate sceptical credentials were at the same level!)

    I’m delighted France has taken this step, if it really has.

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  18. If you are denying some critically ill patients the use of a ventilator, then it becomes ethically indefensible to deny patients access to a treatment which may mean that they do not progress to the point where they will need a ventilator, simply on the basis that the treatment has not been clinically trialled according to all the correct procedures. We are already at that point. Do it Boris. People may well be dying needlessly.

    https://www.telegraph.co.uk/news/2020/03/29/intensive-care-coronavirus-patients-now-limited-reasonably-certain/

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  19. Jaime: I agree. And as the rough-and-ready article Paul pointed to said:

    In UK the government has prohibited its use outside of trial, but that position is probably untenable now as they have to explain why they are not treating patients as France is doing.

    Let’s hope that’s the way things go and speedily. And that there are not nasty side-effects that apply specifically to Covid-19 patients (which has been the concern).

    Moving away from the known facts, sparse as they are, to the conspiracy theory realm, Steve Mc also retweeted this:

    Hmm.

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  20. So no randomisation and high probabilty of selection bias.

    I would not be concerned about that. The people selecting to take an experimental drug treatment are unlikely to be the ones suffering the least. A person near death will clutch at any straw, after all, but a person coping reasonably well will not.

    So while there will be likely selection bias, it will almost certainly work against the treatment.

    It is interesting to see how conflicted much of the medical profession is with the “precautionary principle”. We have to take extraordinary measures, lock-down, and screw our economy because we don’t want to take the risk that people might die, even though we know that it will have massive adverse effects — because we are in an unusual situation. But we shouldn’t give people experimental treatments because that’s not how things are done — and damn the unusual situation, that’s simply not how we do things!

    Basically, people are happy as anything to apply the precautionary principle — but only so long as it is not in their field. Doctors will happily trash the economy, but don’t go messing with how careful medical treatments have to be verified.

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  21. The only mention of hydroxychloroquine on the French government site that I could find was an announcement of clinical trials. Mind you, they’re weeks out of date, viz. This, from their English-language section:

    IS IT SAFE TO COME TO FRANCE?
    France has not been quarantined but there are a few clusters of coronavirus COVID-19 in Oise, Haute-Savoie, Morbihan, Haut-Rhin, Corse du Sud, Aude and Calvados departments. We recommend that you do not travel to these clusters.

    Maybe their website manager is off sick.

    From Libération (the French equivalent of the Guardian) this article:
    https://www.liberation.fr/checknews/2020/03/28/le-vrai-du-faux-de-ce-message-viral-sur-la-chloroquine-raoult-et-agnes-buzyn_1783133
    does a fact checking job on 20 points in a document circulating on social media which makes similar points to the Escobar article. While it finds a few errors of detail, it basically confirms the situation of a conflict of interest between a minister of Health (who claims to have warned the government of catastrophe in January, and insisted that the forthcoming elections should be cancelled, then accepted to be pushed out of her ministry and stood as candidate for mayor of Paris in the same elections); her husband, who, as head of INSERM, the French national medical research body, reined in the independence of university research groups like Professor Raoult’s and deprived them of funding; and a pharmaceutical industry which has a number of expensive molecules undergoing trials, to which hydroxychloroquine was added under media pressure, under clinical conditions which Libération doesn’t specify.

    The article is a typical MSM hatchet job on the dangers of fake news, essentially praising social media with faint damns. For example, it “refutes” the accusation that the authorities were trying to suppress Raoult’s work with this defence of the Ministry:

    As for the Ministry of Health, it tweeted on Feb 26 a “pastille” [avatar thingy?] labelled “désinfox” (debunking fake news) without however qualifying Professor Raoult’s research as “fake news:” explaining that ‘no rigorous study, published in an international, independently peer-reviewed journal has demonstrated the effectiveness of chloroquine (nivaquine) against the Coronavirus infection in humans.’

    No clinical trial has ever demonstrated that washing your hands is effective against coronavirus either. Perhaps half the population should wash their hands, and the other half not? That would be the scientific way.

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  22. I am concerned. Devising the procedure for new drugs or new applications for known drugs is well established and accepted. Now we have an instance that, because of dire need we will accept the product of what I am informed is poor practice – no double-blind testing, even the absence of proper control group, testing patients at a different stage from those the procedure is intended (or so I’ve read). Will we use this case as a precedent? I really hope not, but I can see the same arguments as are being used, here and elsewhere, being used in the future. Yes the drugs are already approved, but not in combination. A thin end of a wedge?

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  23. Interesting factoid? The first blind test was conducted in France in 1784 to investigate the claims of mesmerism. It involved the use of blindfolds.

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  24. The chloroquine plus antibiotic combo is part of the treatment being used by the hospitals in the region of Spain where I live. I know this first hand because I have the opportunity to listen to the Medical society’s phone conferences where they discuss coronavirus issues (they spend a lot of time discussing how not to get infected, handling of patients, etc). They seem so convinced chloroquine helps the debate revolves more around the additional antibiotic treatments, the timing to start the chloroquine, and what has to be measured to see how it’s working. I also heard the UK is starting a large community trial giving chloroquine to individuals as soon as they show first symptoms.

    My impression is the medical system, particularly the one in the US, is too bureaucratic and politically polarized. The media and individuals started badmouthing chloroquine, exaggerating the death of the guy who overdosed on fish cleaner, and making the medicine sound like it’s plutonium. I used to work in malaria areas, and the product was prescribed routinely. As far as I’m concerned everybody over 65 should be taking a dose whether they are sick or not.

    [Sorry for delay – this got stuck in the spam. PM]

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  25. Here’s a substantial blog post on the new results claimed by Raoult,

    https://blogs.sciencemag.org/pipeline/archives/2020/03/29/more-on-cloroquine-azithromycin-and-on-dr-raoult

    by Derek Lowe who apparently has a lot of experience in the pharma industry. It raises the obvious point I made: “Without matched controls, and without being able to look at individual patient data, we just don’t know how good this treatment was or frankly if it was any good at all.”

    He concludes with “I am not yet prepared to say that Dr. Raoult is wrong about hydroxychloroquine and azithromycin. But neither does he seem to be the sort of person who is always a reliable source, either.” which I think is the right approach. Anyone confidently stating that he’s a complete fraud (or alternatively that he’s the Messiah) is on dodgy ground.

    Also, there is now a new pubpeer thread for comments on the 27 March Raoult study:

    https://pubpeer.com/publications/16FA317CB5E5E33232F7E929C86BB0

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  26. PAUL
    Sorry, I’ve only just seen your question about the official French government announcement, which is on their legal site, not the normal one for Coronavirus information. They say that hydroxychloroquine and lopinavir/ ritonavir can only be prescribed, dispensed and administrated under the responsibility of a doctor in medical establishments (and then at home once they’re released.) Rouault’s point is that it’s most useful in the early stages before the patients get to hospital, when they’re being treated by GPs.
    Trustnodes correctly translates this, but draws the wrong conclusion in saying the debate is over.

    Just after reading your last comment I saw this dialogue of the deaf on TV:
    Doust-Blazy (cardiologist and ex-minister of health): The problem is, it can’t be administered by GPs, when it would be useful.

    Doctor in Emergency Services:  No, the problem is, it can’t be administered by GPs, because then it would open the floodgates..etc.

    Hospital Emergency Services have been striking and protesting for over a year about underfunding and lack of facilities, and suddenly they find themselves the heroes of the hour, being promised the earth. It’s hard to blame them for being a bit defensive.

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  27. Been following this emerging hope since before President Trump mentioned it.
    Anthony Watts wrote an article about the hopeful treatment. My CDC contact said it was for real before the President spoke about it.
    Yet the same people who hate climate skeptics and indulge in TDS dismissed this apparently successful and low cost therapy.
    So literally hundreds of thousands of people will heal faster and better and unknown tens of thousands will live due to a drug that in the US was ridiculed and even banned by democrats all because of who spoke out in favor of researching it.

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  28. In fact it’s invented by a belgian virologist Van Ranst, but nobody my use it, France got hectolitres of the stuff, and would you know: all of a sudden it disappeared.

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  29. After reading the PubPeer link (thanks for posting it, Paul), it is clear that a lot of scrutiny and skepticism is warranted. This will not be the last great war where early promising strategies turn out poorly. If I was to advise the President on this I would strongly suggest not being overly specific about specifics. Let the doctors talk treatment. False hope, like false doom, come with multiple costs. The basic question would be why should antmalarial drug do much of anything to a virus, much less an antibiotic. The antibiotic likely suppresses secondary bacterial infections in the fluid filled lungs, which is obviously good. But what does quinine do besides make him taste good and kill malaria parasites?

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  30. The most likely mechanism of action is possibly to do with its effects on lysosomes. Viruses need to enter cells and that often involves binding to host surface proteins and being internalized with them via endocytosis. IIRC, the endocytic vesicles fuse with acidic lysosomes, the contents are broken down, and then released into the cell. If the virus relies on this fact as part of its entry mechanism, disruption could reduce the ability of the virus to infect cells.

    Interestingly, compounds like chloroquine are also being looked at in regards to cancer. Some cancers provide energy by eating themselves under stress (autophagy). This can make them resistant to chemotherapy. By inhibiting autophagy, which involves lysosomal degradation, compounds like chloroquine can enhance sensitivity to chemotherapy.

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  31. Davejr,
    The aquarium cleaner that the couple in Arizona took was a caustic chemical with a similar name to the malarial drug. It would be like taking caustic drain cleaner instead of an antacid because both will neutralize acids.

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  32. From discussion at Lucia’s, and a little research of my own, it appears the fish tank story is flawed. There is no evidence that chloroquine phosphate is used as a fish tank cleaner. Instead, it appears to be used as a treatment for fish :-

    “Chloroquine phosphate is considered a “wonder drug” in the Saltwater Marine aquarium hobby. The drug of choice for many public aquariums including the Georgia Aquarium. It has been widely used by hobbyists in the early days of the marine aquarium hobby and used in the aquaculture industry since the 70s and 80s. It is typically unavailable to the majority of the reefing community due to it normally being available only through a Veterinarian via a prescription.”

    This makes more sense for a number of reasons. The most likely cause of death was over dose.

    Liked by 1 person

  33. I’ll add that chloroquine phosphate can be taken by humans too, but hydroxychloroquine is preferred because it has less chance of side effects.

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  34. Davejr,
    Thank you for clarifying that. It makes a sobering object lesson regarding self medication and partial information.

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  35. Four days after Paul published this article, the debate is still raging in the French media, from A to B and back again. Journalists who yesterday didn’t know what a percentage was are earnestly discussing blind tests and peer review. The problem, they seem to be saying, is not whether Raoul is an attention-seeking narcissistic guru whose treatment is saving thousands of people from miserable suffering and possibly death; the problem is, if I express criticism of the official government line, will I lose my comfortable place in this studio and spend the rest of my career standing in draughty deserted market places with a piece of kitchen towel cellotaped to my face?

    The ambiance resembles nothing so much as 1940. You can hear the official line: “It’s all very well this de Gaulle chap blabbering on about tank warfare. We’re currently in the process of conducting a blind test on the effectiveness of the Maginot line, leaving half of it undefended, and mustering our troops behind the other half. To render it scientific, our generals don’t know which half, only the Germans know that. First results of the experiment are expected in about six weeks.”

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  36. One important thing to remember:
    Before the Raoult study, there were S Korea reports, Chinese reports, and even two American studies. That said, when I heard the President give a clearly qualified mention of this, I told a friend of mine that it is potentially unwise for the leader of anything to talk publicly about so much. There is a saying in Spanish that goes, “A fish is caught by its mouth”. When I see President Trump, I see someone who for good and bad reasons talks too much. His long compound sentences are easy fodder for a corrupt and ignorant press to edit and contort. And the inevitable mistakes that any long free form conversation makes leave plenty of honest sound bites that are damaging. Plus, think 9f the pace the President has kept for the last 3 or 4 weeks. It is grueling and exhausting. But at this point he has been burned and betrayed by so many he has trusted, I can see why he wants to be the full time face of this. Considering the cynical dirty slimeballs who have worked to hurt him, and the country, since 2026, I can see why he doesn’t see an alternative at this time. But I sincerely hope he finds one. On balance he is doing a magnificent job.

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  37. Geoff: “Journalists who yesterday didn’t know what a percentage was are earnestly discussing …” This has grated for me watching the BBC too. Cosy, compared to so many others in society, and self-righteous with it, because they’re criticising politicians in an impossible predicament. I continue to agree with Steve Mc that the balance of risk means HCQ and Zinc should be allowed to treat anyone. Then, if there are negative side-effects, from a drug used since the 1940s, reconsider. But, from what I’ve seen, TV and MSM journalists in the UK haven’t even been pressing the government on this. Far too technical and risky. At least in France your “attention-seeking narcissistic guru” has got the sought attention.

    Hunterson: On balance I’m going to wait and see.

    Though I don’t deny this reality, which applies to HCQ and other things

    He’s never going to say less. But it’s a nice thought.

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  38. On the need for debate, yet the impossibility of knowing enough in time, today I’ve seen

    and

    The mask debate is so intense because both the stakes and the uncertainty levels are so high. “We’re trying to build the plane while we’re flying it,” Hanage said. “We’re having to make decisions with quite massive consequences in the absence of secure data. It’s a nightmare for your average cautious public-health professional.”

    That’s from Ed Yong’s excellent piece in The Atlantic yesterday.

    Ben Pile’s tweet of course shows much common ground with the way most sceptics think about the climate debate but Ed Yong’s article shows one major difference: the lack of any time to do the necessary research, even for those who were experts in viruses and epidemiology to start with. I’ve never kidded myself that in the same fraction of a month I’ll become sufficiently expert to be able to second-guess such people with any confidence. (The complexity of the climate system, and of energy generation and provision, is of course another factor. But some of us have had time to at least get a feel for the basics.)

    It’s not easy to handle but there it is.

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  39. I should have mentioned ages ago that Benoit Rittaud at https://mythesmanciesetmathematiques.wordpress.com
    has been publishing almost daily on the statistics of the Corona virus pandemic. Since he’s possibly the only person in the world to have written a book on the history of the exponential, he’s well worth reading. It’s in French of course, but since the essential arguments are mathematical, they’re easy to follow without much knowledge of the language.

    The latest, by Hubert Dulieu, examines Professor Raoult’s two studies, and gets an Rsquared of 0.98.
    https://mythesmanciesetmathematiques.wordpress.com/2020/04/02/lequipe-du-pr-raoult-a-raison-pourquoi-certains-competents-sont-ils-contre-levidence/

    Liked by 1 person

  40. Others in the UK have probably spotted this but Hydroxychloroquine got a mention in both ‘Daily Briefings” yesterday and today, chaired by health secretary Matt Hancock and Michael Gove respectively. The good news: there are already clinical trials underway in the UK for HCQ as well as other “repurposed” treatments. The bad news (if Steve Mc is right on the balance of risk): it wil be a matter of months not weeks till it would be given widespread go ahead. That timescale was given by the impressive Jonathan Van Tam, deputy CMO, yesterday. I found it striking today that the drug was the only one mentioned by the main man, Michael Gove – who smiled ruefully as he had problems pronouncing it.

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  41. More good news, or possible good news, on HCQ, starting with two veterans of the climate dissident scene:

    This is pretty honest and realistic:

    Some other constructive interactions:

    That last point was one of my concerns about the UK trials announced yesterday and highlighted by Gove today. But we’ll live and learn. Or, I suppose, the alternative.

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  42. More climate dissenter disagreement on the virus and what should be done about hydroxichloroquine.

    Liked by 1 person

  43. We now have a much better idea as to why a drug which treats malaria would be useful to treat Covid-19. It appears that coronavirus is not primarily a respiratory disease but a disease of the red blood cells – just like malaria.

    “According to investor Mike Coudrey, a new study has found that it is not the lungs that are tiring out but rather the inability of red blood cells of carrying oxygen throughout the body that is causing organ failure.

    The findings of the study have led some doctors to question whether it is time to explore new ways of treating coronavirus in the near-term, Coudrey said.

    Dr. Cameron Kyle-Sidell, who works in an intensive care unit in New York stated: “Our therapies are not working. Our ventilators are not able to give enough oxygen. Some are questioning whether this is a lung disease causing blood problems or a blood disease causing lung problems. I don’t know what it is but I know that I’ve never seen it before. People are dying of a disease that we do not understand…They are dying of a diseases that does not make sense to us. A disease for which our usual treatment does not fit.”

    He said: “It is very likely that this is more the case, rather than developing a form of ARDS or pneumonia. Many doctors are starting to believe that they are operating under a false notion of pneumonia, & possibly treating the wrong symptoms on a systematic basis throughout the country.”

    Coudrey emphasized: “Ventilators may not be treating the root cause, as many of the patient’s lungs aren’t ‘tiring out’, they’re pumping just fine. It is instead that the affected hemoglobin have been stripped of their ability to carry oxygen, resulting in hypoxia.”

    One of the drugs that could help with the boost of red blood cells is hydroxychloroquine, a malaria drug that has been used in the U.S. in the past two weeks to treat coronavirus. Since malaria also interferes with red blood cells, the study discovered that the disruption in the cells could be cured with hydroxychloroquine.

    He added: “Hydroxychloroquine is also used for malaria, a pathogen that also interferes with the red blood cells. Malaria uses host hemoglobin as its food source.”

    https://www.24newshd.tv/10-Apr-2020/coronavirus-a-red-blood-cell-disease-not-lungs-new-study

    “The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. Patients returning for re-hospitalization days or weeks after recovery suffering from apparent delayed post-hypoxic leukoencephalopathy strengthen the notion COVID-19 patients are suffering from hypoxia despite no signs of respiratory ‘tire out’ or fatigue.

    How does chloroquine work? Same way as it does for malaria. You see, malaria is this little parasite that enters the red blood cells and starts eating hemoglobin as its food source. The reason chloroquine works for malaria is the same reason it works for COVID-19 — while not fully understood, it is suspected to bind to DNA and interfere with the ability to work magic on hemoglobin. The same mechanism that stops malaria from getting its hands on hemoglobin and gobbling it up seems to do the same to COVID-19 (essentially little snippets of DNA in an envelope) from binding to it. On top of that, Hydroxychloroquine (an advanced descendant of regular old chloroquine) lowers the pH which can interfere with the replication of the virus. Again, while the full details are not known, the entire premise of this potentially ‘game changing’ treatment is to prevent hemoglobin from being interfered with, whether due to malaria or COVID-19.”

    https://web.archive.org/web/20200405061401/https://medium.com/@agaiziunas/covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-91182386efcb

    That was 8 days ago. Why is AZ/HCQ still not being routinely used to treat Covid patients?

    Liked by 2 people

  44. Covid-19 is NOT like pneumonia; it is not your typical ARDS (acute respiratory distress syndrome). If what this doctor is saying is true, the entire mediacal profession is taking the wrong approach to treating this disease and may even be making patients worse.

    Liked by 2 people

  45. Jaime, Ron Clutz has an excellent article on exactly this issue.

    https://rclutz.wordpress.com/2020/04/12/easter-news-covid-killing-secret-exposed/

    Thank you for posting the video. President Trump claimed he had a gut feeling about this drug and frankly it is looking like he was correct.
    So increasingly the Chinese style economic shutdown is looking like a much less than optimal strategy. And consensus medicine apparently failed us. And lets not start in our vicious legacy media and the childish opposition party. .
    The gut feeling of a President all too many have galvanic reactions to looks like someone who deserves a lot more respect.

    Liked by 1 person

  46. Well done to Ron for picking up on this. I’ve been doing some digging and come up with some facts about this disease which tend to support the theory that it’s not lung damage per se which is causing the unusual levels of hypoxia in Covid patients, but ‘something else’. Will share that later when I’ve walked the dogs.

    I’m coming to the view that western governments could not have made a worse pigs breakfast of their response to this disease, even if they’d tried. We’re facing catastrophic economic meltdown, continued loss of civil liberties, unnecessary deaths due to both medical and political incompetence – and now we’ve got synchronised twerking videos by overworked and incredibly stressed NHS heroes all over the internet! I can’t keep up.

    Liked by 3 people

  47. ‘The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. Patients returning for re-hospitalization days or weeks after recovery suffering from apparent delayed post-hypoxic leukoencephalopathy strengthen the notion COVID-19 patients are suffering from hypoxia despite no signs of respiratory ‘tire out’ or fatigue.’ H/t Ron Clutz blog.’

    This is why Malaria treatment appears to be effective if used in the virus’ early stages. Do-not-listen to-the-toxic,-panic-propagating-fake-press- they’re merchants of doubt, .but not in a good way.

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  48. So there are two alternative explanations concerning how coronavirus kills us. It attacks the lining of our lungs and we cannot absorb oxygen efficiently, or it binds with heme groups in red blood cells so oxygen cannot be carried around the body (so supplying more oxygen is ineffective). Two very different mechanisms that it should not be beyond the wit of pathologists to distinguish between. If lung failure is accompanied by buildup of iron (released from destroyed heme), this should be different perhaps from the symptoms of pneumonia. So…why aren’t we hearing about this?

    Liked by 1 person

  49. That’s the greatness of evidence-based medicine. When you treat victims according to a theory of the disease, and people get worse and die, rather than improving, the theory is proven wrong and has to change. That appears to be happening now, driven by observations from the field doctors and nurses caring for infected people.
    If only there were some actual victims of global warming/climate change, (instead of kids with lawyers) perhaps that theory could be dislodged. As it is, we have no planet “B”, so we should not change how we care for this one unless and until Earth gets a fever.

    Liked by 2 people

  50. “Even as hospitals and governors raise the alarm about a shortage of ventilators, some critical care physicians are questioning the widespread use of the breathing machines for Covid-19 patients, saying that large numbers of patients could instead be treated with less intensive respiratory support.

    If the iconoclasts are right, putting coronavirus patients on ventilators could be of little benefit to many and even harmful to some.

    What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen.

    That is making critical care physicians suspect that blood levels of oxygen, which for decades have driven decisions about breathing support for patients with pneumonia and acute respiratory distress, might be misleading them about how to care for those with Covid-19.

    But because in some patients with Covid-19, blood-oxygen levels fall to hardly-ever-seen levels, into the 70s and even lower, physicians are intubating them sooner. “Data from China suggested that early intubation would keep Covid-19 patients’ heart, liver, and kidneys from failing due to hypoxia,” said a veteran emergency medicine physician.”

    https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/

    This is from a letter to a medical journal from several Italian doctors:

    “In northern Italy an overwhelming number of patients with Covid-19 pneumonia and acute respiratory failure have been admitted to our Intensive Care Units. Attention is primarily focused on increasing the number of beds, ventilators and intensivists brought to bear on the problem, while the clinical approach to these patients is the one typically applied to severe ARDS, namely high Positive End Expiratory Pressure (PEEP) and prone positioning. However, the patients with Covid-19 pneumonia, fulfilling the Berlin criteria of ARDS, present an atypical form of the syndrome. Indeed, the primary characteristics we are observing (confirmed by colleagues in other hospitals), is the dissociation between their relatively well preserved lung mechanics and the severity of hypoxemia.”

    https://www.atsjournals.org/doi/pdf/10.1164/rccm.202003-0817LE

    Liked by 1 person

  51. Not quite two different mechanisms because removing the iron from hemoglobin may be responsible for oxidative lung damage, which the theory proposes is a cause, or contributing cause, of the ARDS which is also an issue (which is essentially a thickened alveoli/capillary membrane which slows diffusion of oxygen into the blood). So there is overlap.

    There is biochemical data suggesting CV19 may have such an effect on hemoglobin, but, I agree that the physiological evidence should be more prevalent. While there is some literature pointing to anemia (many patients are old and it is therefore to be expected to some degree), it doesn’t seem to have set off any alarms.

    Regarding the video, the thing about positive pressure ventilation is that only the necessary amount of pressure is used. These people aren’t getting oxygen, so pressure is increased. which may cause damage. It’s a Catch 22 that I didn’t see him provide an alternative to.

    Additionally, ARDS is treated using ventilators and positive pressure. It’s the only widely available treatment available and it’s not just about replacing tired diaphragm muscles. The pressure is a key element because, not only does it ensure that all the alveoli are accepting gas, it’s also a way of increasing the rate of diffusion across the membrane by increasing the pressure. There are two other possible options, apart from ventilators, to force oxygen into people. A hyperbaric chamber and ECMO. The hyperbaric chamber allows you to increase the pressure beyond that of a ventilator which increases the rate of diffusion but again, you have pressure issues. ECMO is basically piping the blood out of the body, oxygenating it, and putting it back in, like dialysis for the lungs. Neither of these options are available in large supply.

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  52. Not too many hyperbaric chambers around DaveJr! Plentiful supply of HCQ/AZ which if administered at the first sign of hypoxia, or even before, might prevent many patients progressing to more severely depleted blood oxygen levels which will in turn damage internal organs.

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  53. OK so I’m not au fait with the distinctive symptoms of how Coronavirus causes us harm, but surely if the ability of red blood cells is impaired then this should be testable by exposing a blood sample to oxygen. If its a lung disease the blood sample should become oxygenated. If its a blood disorder, exposure to oxygen should have little effect.

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  54. To lock down or not to lock down? That is the question, to which I don’t know the answer, but I commend this website, which is at least asking a lot of the right questions, and trying to stimulate a debate, while being open to argument either way:

    https://lockdownsceptics.org/

    Apologies if it’s been mentioned already, I’m not online much at the moment, as it’s all (NB, all the internet, not cliscep) just so depressing. I’m concentrating on my backlog of books instead. 🙂

    Liked by 2 people

  55. It should certainly be testable, Alan. If the iron is physically dissociated from hemoglobin as I’ve seen suggested, I would have thought it would show up in basic blood tests to measure hemoglobin levels.

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  56. Mark,

    An Israeli professor sees no real difference in trends between lockdown countries and no-lockdown countries. Covid-19 appears to be following a predictable path regardless of whether the populace are imprisoned in their homes whilst the economy is wrecked, or not.

    “This is how it is all over the world. Both in countries where they have taken closure steps like Italy and in countries that have not had closures like Taiwan or Singapore. In such and such countries there is an increase until the fourth to sixth week, and immediately thereafter moderation until during the eighth week it disappears.”

    http://www.israelnationalnews.com/News/News.aspx/278658

    James Annan has had a go at pandemic modelling and comes up with this interesting graph. 16 days and it will be all over as far as huge numbers of deaths and new infections go, according to his model.

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  57. By the way, if lockdown really worked then you might expect, of all places, care homes, where residents don’t leave the house and grounds, and where visitors can be tightly regulated and staff scrupulously careful to ensure that they minimise the risk of transferring any infection to those in their care, to be relatively free of infection. They’re not, apparently. The epidemic is sweeping through them and killing huge numbers – apparently. This either means that care home managers have been extremely negligent in protecting their elderly residents or Covid-19 is almost impossible to contain, even in a locked down microcosm like a care home.

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  58. @ Jaime

    There is no way to contain coronavirus in a care home. Once it’s in the front door, you’ve had it. It’s impossible to to explain social distancing to folks with dementia, and even if you isolate affected individuals, they will be infectious before symptomatic.

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  59. Yes JIT, I was rather thinking more in terms of how it should be possible to keep it out of the care home in the first place, but it’s probably not, considering the nature of this virus. Which begs the question, is this partial lockdown, which is destroying the economy, costing lives now and which will inevitably cost many more lives in the future, really doing much to contain the spread of a virus which is so difficult to contain anyway?

    Liked by 1 person

  60. Not just may individuals be infectious before showing symptoms, they may be infectious and have no symptoms at all at any time. The degree to which this happens has yet to be properly characterised, but it could be a large number. For example, this quick study screening pregnant women going in for delivery found that, of 215 patient screened, 33 had the virus. Of those 33, only 4 had symptoms.
    https://www.nejm.org/doi/pdf/10.1056/NEJMc2009316?articleTools=true

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  61. In the US the challenge of nursing homes has been that many of the workers have jobs at multiple locations. This means that the workers can be the vectors of infection, spreading the virus from facility to facility. Few healthy people live in nursing homes. Once the virus gets in such an environment it can inflict a lot of serious illness and death. The growing evidence is that this epidemic originated in the disease lab near the Wuhan wet market. The lab kept in captivity the out of region bat that is the natural carrier for this virus. The market did not sell that species of bat. The Chinese government disappeared those early journalists and medical professionals who tried to tell the world about this. China has lied about their infection experience and mortality rate. Chin is showing unprecedented control of media, with American media preferring Chinese propaganda since it joins them in hating Trump. China has claimed that the malarial drugs are not working. China sent faulty medical equipment to Europe and elsewhere, why Chinese agents bought out whole inventories of supplies short in China, including medical equipment.
    America, at least, was obsessed with the story, now proven to be whole cloth fiction, of Russian penetration of the US. Meanwhile China has actually done it. And shown it via a disease they let loose on the world.
    These are disturbing time.

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  62. Thanks for that Geoff. I’m a bit busy at the minute but I will most certainly read it.

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  63. Geoff,

    I’ve read the ‘Automatic Earth’ article now. For the most part, it was a pretty standard espousal of the precautionary principle. However, the following statement did stand out for me:

    “You can’t argue that a lockdown might cost jobs if and when a non-lockdown will cost lives; you can’t argue for measures that kill people.”

    This is typical of the type of asymmetric view that one finds in people who are advocating the PP. It is not a matter of trading off people’s lives against jobs. The problem here is that people’s lives are at stake either way. The measures taken to reduce COVID-19 deaths are themselves likely to cause deaths – as Chris Whitty never tires of telling us. Often the PP eats itself: In the interests of precaution, I might advocate a lockdown but the PP warns against it! Even if the lockdown penalty is purely financial, one cannot say that lives will not be lost as a result of the economic damage. The calculation may be obscure, but it is still there.

    The bottom line is that when one takes decisions under profound uncertainty the PP is necessary but will not necessarily be sufficient. There is no substitute for data.

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  64. The “economy” vs “lives” is a simple dichotomy that is easy to defend on one side, but much more complex on the other.

    I liken these arguments to a sinking ship with a limited number of lifeboats. The simplistic moral argument states that you should pack as many people into the lifeboats as possible to save as many lives as possible. The more complex moral argument states that doing so could end up killing everyone and that some must unfortunately die so others can live. For a number of reasons, many prefer the simplicity, ease of defense, and moral “selfishness”, of the first choice (at least they tried to save everyone, which is more than can be said for those heartless people who would have deliberately chosen to let some die).

    Liked by 2 people

  65. JOHN RIDGWAY
    Yes that statement stood out for me too, because it’s false. “You can’t argue for..” is false because you can always argue for something. Taleb means you shouldn’t argue for jobs over lives, but even that’s not obvious, if you take the image of a “war against covid 19” seriously.

    Often the PP eats itself.

    Always the precautionary principle eats itself. It’s its own after-birth. Nothing is risk-free. “Don’t go in there, there might be a monster inside.” But there might be a monster outside too. The PP is a polysyllabic pleonasm for “take care.”

    Liked by 1 person

  66. DAVEJR’s comment says much the same thing, more pithily. It reminds me of a mind game I’ve invented which I mean to turn into a post some time. You’re in a lifeboat-for-two with two other people, and you decide to vote who will be thrown overboard. Call the other two – say – Hitler and Michael Mann. Who do you try to persuade to vote with you, and what argument do you use?

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  67. Back to the original subject of this thread. What do we make of the following developments?

    Those news outlets may not be our, or President Trump’s, favourites. But I doubt the relative silence is a complete myth either.

    On other medical developments:

    The first damning critic I saw at least met his match with concision here:

    I don’t feel like an expert in this area, any more than I did before. What about this, prompted by the New York Times, and the discussion that follows?

    Yep, I don’t know either. Stay well, Cliscep readers.

    Like

  68. Didier Raoult has hit back, pointing out a number of obvious faults with the veterans hospital ‘study’, as reported by Laura Ingraham of Fox here:

    “Big Pharma does not make its money on cheap generics” she says near the end.

    As a follower of Edmund Burke, that explanation makes sense to me. (It always did.)

    Like

  69. The NYT article seems like a well reasoned good idea. The pulse ox wouldn’t be necessary, but would be certainly be useful for urging the “tough it out” crowd to action, and the over-reactors to calm down. Simply being aware that you’re having more problems breathing than normal and that you shouldn’t wait to get it checked out would be a good start which doesn’t require any special equipment.

    Liked by 1 person

  70. Didier Raoult has hit back again, this time against “one of the lead members of the Trump Administration’s White House Coronavirus Task Force addressing the 2019–20 coronavirus pandemic in the United States.” That’s from Wikipedia, which then assures me “Fauci is widely seen to be one of the most trusted medical figures in the country.”

    Liked by 1 person

  71. Raoult had 2 hours of prime time TV on a major news channel last night – a 30 minute hatchet job documentary followed by an hour-long interview followed by a studio discussion. In the interview he hammered away at a few simple points which the interviewer seemed to understand, until the next question which showed she hadn’t. He wasn’t interested in his reputation as a rock star/ Robin Hood / rebel. He wasn’t interested in politics, which he acknowledged was a difficult profession, with lots of unknowns etc. He didn’t do modelisation or soothsaying. He didn’t know if there’d be a second wave or antibody immunisation. He didn’t know anything except what had been published and what he discovered in his own treatment and research. The opposition to hydroxychloroquine was the weirdest thing he’d ever encountered in his career; he wouldn’t speculate as to what was behind it. Ask a sociologist.

    The discussion afterwards demonstrated that the journalists are totally autistic. “What a character! I wonder what his motivations are? What’s he hiding? Quick! Find us an expert who can read the entrails!”

    His climate scepticism got a three-second mention as typical of his eccentricity. Look for the interview at BFMTV. Maybe someone will do a subtitled version.

    Liked by 1 person

  72. Geoff:

    He wasn’t interested in his reputation as a rock star/ Robin Hood / rebel. He wasn’t interested in politics, which he acknowledged was a difficult profession, with lots of unknowns etc. He didn’t do modelisation or soothsaying. He didn’t know if there’d be a second wave or antibody immunisation. He didn’t know anything except what had been published and what he discovered in his own treatment and research. The opposition to hydroxychloroquine was the weirdest thing he’d ever encountered in his career; he wouldn’t speculate as to what was behind it. Ask a sociologist.

    That is *very* impressive. (I hope your reporting is as true as can be, therefore.) I salute Dr Raoult and make a note to become more like him.

    Like

  73. It seems me that the evidence supporting remdesivir is what typically falls into the anecdotal and premature category, but for some reason has way better positive coverage compared to other possible treatments.

    Liked by 1 person

  74. The point of mentioning that key moment in 2006 being of course that ‘denier’ and ‘denialism’ made their inauspicious debut the following year. Almost as if the manipulators that be were worried by the emergence of an honest Curry-McInytre dialogue. (And so they should have been.)

    I’ve opened the ZeroHedge piece and will report back. Topsy-turvy, as Richard North just said.

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  75. Assuming Hoofnagle is a reliable witness on the remdesivir ‘shenanigans’, as reported by ZeroHedge, it’s appalling and says nothing good about Dr Fauci. I didn’t bother to go into incognito mode to read his tweets directly, lest the poor chap be infected by a denialist. Thanks for the pointer.

    Like

  76. I agree with Willis. This is about much more than HCQ but it sure is about that and the freedom for clinicians to use it.

    Lead author Marcos Nogueira Eberlin mentions climate in passing, with just a hint of scepticism. His own scientific record as a mass spectrometrist sounds first class.

    Liked by 1 person

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