A game changer - Printable Version
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A game changer - BostonCard - 09-02-2020
While Trump has distracted everybody with discussions of disproven therapies like hydroxychloroquine and possibly beneficial but unproven therapies like convalescent plasma (more on that, here: https://www.fiercepharma.com/pharma/rebuking-fda-nih-experts-say-no-data-support-plasma-as-a-covid-19-treatment), the one proven treatment has not been mentioned. I'm not sure if it's because the ship has sailed already, and Trump saying it's a game-changer would be greeted by "we're already doing that" and a meh. But I was reviewing some charts recently, and counted the proportion of patients on this cheap, readily available treatmemt, and just over 50% were, which means that half the patients didn't receive a therapy that could cut their risk of death by a third.
The treatment is corticosteroids. I mentioned the outcome of the recovery trial earlier (https://www.nejm.org/doi/full/10.1056/NEJMoa2021436), which showed that dexamethasone reduced the risk of mortality by 17% (on a relative, not absolute basis; the absolute risk difference is 2.8%, which means that you save 1 life for each 38 people COVID patients you treat with dexamethasone. The effect was most noticeable in the sickest patients; the relative risk of death in patients is 0.64 and the risk difference was 12.1%, so you would save 1 life for every 8 COVID-19 patients on mechanical ventilators treated with dexamethasone.
Of course, that was only one study, so it would be useful to see that replicated. So, a new meta analysis published in JAMA is really helpful (https://jamanetwork.com/journals/jama/fullarticle/2770279). The study looked at 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19 in 12 countries. It included the recovery trial, which was the single biggest source of patients for the meta analysis, but the results were pretty consistent across studies and steroid types (dexamethasone, methylprednisolone, or cortisone). I would still want to see at least one more well-powered study (multiple hundreds of patients) to confirm the Recovery trial findings, but if I had a patient in front of me with severe COVID requiring oxygen or (especially) if mechanically ventilated, I would not hesitate to put them on 5 days of dexamethasone.
It's as close to a game-changer as you can reasonably expect in this disease, and I wish the President would have touted it, instead of disproven or inadequately proven therapies.
BC
lex24 - lex24 - 09-02-2020
(09-02-2020, 05:20 PM)BostonCard Wrote: While Trump has distracted everybody with discussions of disproven therapies like hydroxychloroquine and possibly beneficial but unproven therapies like convalescent plasma (more on that, here: https://www.fiercepharma.com/pharma/rebuking-fda-nih-experts-say-no-data-support-plasma-as-a-covid-19-treatment), the one proven treatment has not been mentioned. I'm not sure if it's because the ship has sailed already, and Trump saying it's a game-changer would be greeted by "we're already doing that" and a meh. But I was reviewing some charts recently, and counted the proportion of patients on this cheap, readily available treatmemt, and just over 50% were, which means that half the patients didn't receive a therapy that could cut their risk of death by a third.
The treatment is corticosteroids. I mentioned the outcome of the recovery trial earlier (https://www.nejm.org/doi/full/10.1056/NEJMoa2021436), which showed that dexamethasone reduced the risk of mortality by 17% (on a relative, not absolute basis; the absolute risk difference is 2.8%, which means that you save 1 life for each 38 people COVID patients you treat with dexamethasone. The effect was most noticeable in the sickest patients; the relative risk of death in patients is 0.64 and the risk difference was 12.1%, so you would save 1 life for every 8 COVID-19 patients on mechanical ventilators treated with dexamethasone.
Of course, that was only one study, so it would be useful to see that replicated. So, a new meta analysis published in JAMA is really helpful (https://jamanetwork.com/journals/jama/fullarticle/2770279). The study looked at 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19 in 12 countries. It included the recovery trial, which was the single biggest source of patients for the meta analysis, but the results were pretty consistent across studies and steroid types (dexamethasone, methylprednisolone, or cortisone). I would still want to see at least one more well-powered study (multiple hundreds of patients) to confirm the Recovery trial findings, but if I had a patient in front of me with severe COVID requiring oxygen or (especially) if mechanically ventilated, I would not hesitate to put them on 5 days of dexamethasone.
It's as close to a game-changer as you can reasonably expect in this disease, and I wish the President would have touted it, instead of disproven or inadequately proven therapies.
BC
If Trump touted it, the effectiveness would drop and he’d be accused of preaching false hope. Doesn’t stop others from touting it. Why hasn’t it been?
RE: A game changer - BostonCard - 09-02-2020
https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1
https://www.nature.com/articles/d41586-020-01824-5
There have been, but I think Trump sucks out all the oxygen. Let’s face it, even someone like Fauci touting dexamethasone is not going to get nearly the press of Trump touting hydroxychloroquine. Now maybe the problem is the press, hanging on Trumps every word like moths to a flame, but the guy is President, not random joe on the street.
BC
RE: lex24 - fullmetal - 09-03-2020
(09-02-2020, 06:58 PM)lex24 Wrote: If Trump touted it, the effectiveness would drop and he’d be accused of preaching false hope.
Don't be such a martyr on his behalf. If Trump promoted a proven treatment that had the backing of the majority of medical science, I don't think anyone would offended...maybe not even if Trump decided to purchase massive equities holdings in such companies the day before his announcement...
Anyway, most of us are starved for common sense and normalcy, so if Trump wants to start acting like a real president, I don't think anyone's going to protest. In fact a lot of people would probably be stunned into silence.
RE: lex24 - teejers1 - 09-03-2020
(09-03-2020, 10:50 AM)fullmetal Wrote:(09-02-2020, 06:58 PM)lex24 Wrote: If Trump touted it, the effectiveness would drop and he’d be accused of preaching false hope.
Don't be such a martyr on his behalf. If Trump promoted a proven treatment that had the backing of the majority of medical science, I don't think anyone would offended...maybe not even if Trump decided to purchase massive equities holdings in such companies the day before his announcement...
Anyway, most of us are starved for common sense and normalcy, so if Trump wants to start acting like a real president, I don't think anyone's going to protest. In fact a lot of people would probably be stunned into silence.
Like the stock market (which I "get" Trump has little to do with - but he'll no doubt claim credit).
And hey, I admit to being stunned with what's going on - in a non-objectionable sort of way, for 401k purposes.
But I'm also honest enough to admit that if the market were at 29,000 under President Obama during a WW pandemic, the reporting on it would be completely different that what we're seeing now.
RE: lex24 - BostonCard - 09-03-2020
(09-03-2020, 12:04 PM)teejers1 Wrote:(09-03-2020, 10:50 AM)fullmetal Wrote:(09-02-2020, 06:58 PM)lex24 Wrote: If Trump touted it, the effectiveness would drop and he’d be accused of preaching false hope.
Don't be such a martyr on his behalf. If Trump promoted a proven treatment that had the backing of the majority of medical science, I don't think anyone would offended...maybe not even if Trump decided to purchase massive equities holdings in such companies the day before his announcement...
Anyway, most of us are starved for common sense and normalcy, so if Trump wants to start acting like a real president, I don't think anyone's going to protest. In fact a lot of people would probably be stunned into silence.
Like the stock market (which I "get" Trump has little to do with - but he'll no doubt claim credit).
And hey, I admit to being stunned with what's going on - in a non-objectionable sort of way, for 401k purposes.
But I'm also honest enough to admit that if the market were at 29,000 under President Obama during a WW pandemic, the reporting on it would be completely different that what we're seeing now.
Do you have evidence of that? I mean the S&P 500 increased over 200% during Obama's two terms (from around 900 in January 2009 to around 2250 in January 2017) and yet you have articles like this: https://www.theatlantic.com/business/archive/2012/10/how-much-credit-does-obama-deserve-for-the-stock-market-recovery/263934/?gclid=EAIaIQobChMIjY7Y-t3N6wIVkh6tBh1DAA7wEAAYASAAEgKfBvD_BwE saying "Most of the stock market growth in the last three years has occurred neither because of, nor in spite of, the president's policies. This shouldn't come as a brobdingnagian surprise. The president controls one branch of government, the federal government accounts for merely one-fourth of GDP, and today the U.S. economy is merely a slice (albeit a big slice) of multinational companies' revenue pie."
Even during the Obama administration, most articles I read correctly noted that the President has a limited effect on the stock market. Then again, Obama never said "You're so lucky to have me as your President" in relation to the stock market's performance:
https://www.marketwatch.com/story/trump-touts-dows-surge-to-29-000-youre-so-lucky-to-have-me-as-your-president-11599081169
BC
RE: A game changer - Mick - 09-03-2020
I think there was a reason that James Carville admonished Bill Clinton's staff that "It's the economy, stupid." They turned out GHWB as president after one term because the economy was tanking. Bill Clinton never forgot that advice, and it's Trump's only advantage, or was until COVID came around.
And to be candid, Presidents do affect the markets -- stock market, labor market, other markets -- with their macroeconomic policies, pronouncements, executive orders, as advocates and by whom they emplace in governmental positions. They're not divorced from the process, not by a long shot.
RE: A game changer - DocSavage87 - 09-03-2020
(09-03-2020, 01:24 PM)Mick Wrote: I think there was a reason that James Carville admonished Bill Clinton's staff that "It's the economy, stupid." They turned out GHWB as president after one term because the economy was tanking. Bill Clinton never forgot that advice, and it's Trump's only advantage, or was until COVID came around.
And to be candid, Presidents do affect the markets -- stock market, labor market, other markets -- with their macroeconomic policies, pronouncements, executive orders, as advocates and by whom they emplace in governmental positions. They're not divorced from the process, not by a long shot.
For the stock market and this one in particular, "It's the Fed, stupid." Or as others say, don't fight the Fed. Various forms of incentive that get lumped in to QE-like policies. The stock market seems divorced from the economy and pretty much driven by some sectors like Tech, which in some ways got a boost from remote work, increased internet use, etc. Just about everyone I follow also says this is going to come crashing down soon, but then they've been saying that for a couple of years. The Fed is winning.
RE: A game changer - fullmetal - 09-03-2020
Market fluctuations come and go, but today's activity was not great. I think everyone is looking ahead to Oct. 1st, when the PPP loan requirements expire.
The rest of us are watching the increasing number of evictions right now and wondering what will happen to the suddenly unhoused in the meantime.
RE: A game changer - BostonCard - 09-03-2020
I mean, you can probably attribute some of the increase in the stock market during Trump's term to the tax cuts he passed, but on the other hand, Obama and Trump are about as politically different as you can reasonably expect, and yet, COVID blip aside, the stock market has performed pretty similarly for both of them.
![[Image: image.png]](https://www.evernote.com/l/ACzH89IvfY5LDZXqt-tt3TP4EyPZ5R649ggB/image.png)
(09-03-2020, 01:47 PM)fullmetal Wrote: Market fluctuations come and go, but today's activity was not great. I think everyone is looking ahead to Oct. 1st, when the PPP loan requirements expire.
The rest of us are watching the increasing number of evictions right now and wondering what will happen to the suddenly unhoused in the meantime.
The CDC put an eviction moratorium in place, which should stem the number of evictions.
https://www.npr.org/sections/coronavirus-live-updates/2020/09/01/908581048/sweeping-new-eviction-ban-from-trump-administration
A good move by the administration under the circumstances.
BC
RE: A game changer - Mick - 09-03-2020
(09-03-2020, 01:47 PM)BostonCard Wrote: I mean, you can probably attribute some of the increase in the stock market during Trump's term to the tax cuts he passed, but on the other hand, Obama and Trump are about as politically different as you can reasonably expect, and yet, COVID blip aside, the stock market has performed pretty similarly for both of them.
Just a minor nit, but Pres. Obama's market growth happened at the beginning, middle and what would normally be considered to be the end of a bull market. And these typically occur after recessions, particularly after The Great Recession. Trump's growth started to happen when expansions historically have faded, he extended the longest bull market in history. It's a much more difficult trick than improved growth after a recession.
Also (speaking of the Fed), Obama's growth occurred when the Fed's core rate was 0.25%, and remained so for the first seven years of Pres. Obama's eight year terms. Rates started increasing a bit in Obama's eighth year (by a sliver) then skyrocketed and continued to accelerate during Trump's first three years. They only reduced when COVID appeared.
https://www.macrotrends.net/2015/fed-funds-rate-historical-chart
RE: A game changer - DocSavage87 - 09-03-2020
(09-03-2020, 02:27 PM)Mick Wrote:(09-03-2020, 01:47 PM)BostonCard Wrote: I mean, you can probably attribute some of the increase in the stock market during Trump's term to the tax cuts he passed, but on the other hand, Obama and Trump are about as politically different as you can reasonably expect, and yet, COVID blip aside, the stock market has performed pretty similarly for both of them.
Just a minor nit, but Pres. Obama's market growth happened at the beginning, middle and what would have been presumed to be the end of the longest bull market in history. Trump's growth happened when expansions historically have faded.
Also (speaking of the Fed). Obama's growth occurred when Fed's rate was 0.25%, and remained so for Pres. Obama's entire eight year term. Rates started increasing a bit in Obama's eigth year (by a sliver) then skyrocketed and continued to accelerate during Trump's first three years. They only reduced when COVID appeared.
https://www.macrotrends.net/2015/fed-funds-rate-historical-chart
https://www.macrotrends.net/2015/fed-funds-rate-historical-chart
You might also want to mention why the Fed's rate was that low and what happened prior to Obama taking over. And yeah, you can juice the market in a number of ways including tax cuts and also the global conditions -- like where you can actually put your money. It's not like US exists in a vacuum. And the stock market isn't the economy. Let's see what happens when the constant stimulus subsides.
RE: A game changer - BostonCard - 09-03-2020
(09-03-2020, 02:27 PM)Mick Wrote:(09-03-2020, 01:47 PM)BostonCard Wrote: I mean, you can probably attribute some of the increase in the stock market during Trump's term to the tax cuts he passed, but on the other hand, Obama and Trump are about as politically different as you can reasonably expect, and yet, COVID blip aside, the stock market has performed pretty similarly for both of them.
Just a minor nit, but Pres. Obama's market growth happened at the beginning, middle and what would have been presumed to be the end of the longest bull market in history. Trump's growth happened when expansions historically have faded.
Also (speaking of the Fed). Obama's growth occurred when Fed's rate was 0.25%, and remained so for Pres. Obama's entire eight year term. Rates started increasing a bit in Obama's eigth year (by a sliver) then skyrocketed and continued to accelerate during Trump's first three years. They only reduced when COVID appeared.
https://www.macrotrends.net/2015/fed-funds-rate-historical-chart
https://www.macrotrends.net/2015/fed-funds-rate-historical-chart
Not a nit; your point reinforces mine that timing is everything in the market, even if you are President. I shouldn't have been so flippant in saying that Presidents don't affect the market; as mentioned, Trump's tax cuts probably helped in the short term. However, timing and luck probably have a lot more to do with it than policy. The business cycle will do what the business cycle does, and to my knowledge the President has a marginal impact on the business cycle. Obama was lucky; had his Presidency started a year earlier, stock market performance under his term would look a lot worse. George W Bush was unlucky; things would have looked better if he didn't inherit a market that was near its short term peak and about to crash.
BC