[martyup]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

[martyup]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

[2006alum]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

IMHO, there's a gulf between what I think is a somewhat non-credible statement that "the top medical minds in the world are recommending it" -- when half the top medical minds I read daily have skepticism that this is a game-changer, many are noting that is raises a lot of potential side-effects that might be as harmful as it is helpful, and actual ER docs in NY and NJ who have been prescribing have not seen miraculous differences in patient outcomes -- and the "let's reserve final judgment until we get enough data" position, which seems to be the rest of us.

In other words, do you genuinely think anyone here is expressing that they would be disappointed if it saved hundreds of thousands of lives? 

Edited to add: looks like Fauci is not yet among those top medical minds who think this is a gamechanger:
[tweet]https://twitter.com/CNBC/status/1246082156180406272?s=20[/tweet]

From Fauci himself: "Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warned Friday that there isn't any "strong" evidence that an anti-malaria drug has proven effective in the coronavirus fight."

But this is the problem with our leadership right now, which makes non-credible claims that experts and the media feel the need to clarify/debunk. One camp then feels the need to defend those claims regardless of the strength of the evidence, and the other camp wants to dunk them to prove how non-credible they are. And that is how science becomes political.

Imagine if no one had taken to Twitter and boldly proclaimed chloroquine + azith was a GAMECHANGER. Maybe none of us would feel the need to start having such strong reactions to small-n clinic trials.

[2006alum]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

IMHO, there's a gulf between what I think is a somewhat non-credible statement that "the top medical minds in the world are recommending it" -- when half the top medical minds I read daily have skepticism that this is a game-changer, many are noting that is raises a lot of potential side-effects that might be as harmful as it is helpful, and actual ER docs in NY and NJ who have been prescribing have not seen miraculous differences in patient outcomes -- and the "let's reserve final judgment until we get enough data" position, which seems to be the rest of us.

In other words, do you genuinely think anyone here is expressing that they would be disappointed if it saved hundreds of thousands of lives? 

Edited to add: looks like Fauci is not yet among those top medical minds who think this is a gamechanger:
[tweet]https://twitter.com/CNBC/status/1246082156180406272?s=20[/tweet]

From Fauci himself: "Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warned Friday that there isn't any "strong" evidence that an anti-malaria drug has proven effective in the coronavirus fight."

But this is the problem with our leadership right now, which makes non-credible claims that experts and the media feel the need to clarify/debunk. One camp then feels the need to defend those claims regardless of the strength of the evidence, and the other camp wants to dunk them to prove how non-credible they are. And that is how science becomes political.

Imagine if no one had taken to Twitter and boldly proclaimed chloroquine + azith was a GAMECHANGER. Maybe none of us would feel the need to start having such strong reactions to small-n clinic trials.

[BostonCard]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

One would have to be a truly f'd up human being to hope that a potential drug to treat a pandemic that might kill millions of Americans doesn't work just because it doesn't align with political viewpoints.

BC

[BostonCard]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

One would have to be a truly f'd up human being to hope that a potential drug to treat a pandemic that might kill millions of Americans doesn't work just because it doesn't align with political viewpoints.

BC

[burger]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

One would have to be a truly f'd up human being to hope that a potential drug to treat a pandemic that might kill millions of Americans doesn't work just because it doesn't align with political viewpoints.

BC

And, for the record, I am not a truly f'd up human being.  I think I'll just let what BC and 2006alum said stand for what I wanted to say, which would have involved more cursing.

[burger]

It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants. 

Cocaine was once considered a miracle drug:

https://www.pbs.org/newshour/show/cocain...am-halsted

Especially when optimism aligns with people's political opinions.

The same could be said about pessimism.

One would have to be a truly f'd up human being to hope that a potential drug to treat a pandemic that might kill millions of Americans doesn't work just because it doesn't align with political viewpoints.

BC

And, for the record, I am not a truly f'd up human being.  I think I'll just let what BC and 2006alum said stand for what I wanted to say, which would have involved more cursing.

[2006alum]

More on why some of the studies being cited should be greeted with caution, and specifically the one that folks were discussing earlier in this thread:

[tweet]https://twitter.com/V2019N/status/1246142845892739072?s=20[/tweet]

[2006alum]

More on why some of the studies being cited should be greeted with caution, and specifically the one that folks were discussing earlier in this thread:

[tweet]https://twitter.com/V2019N/status/1246142845892739072?s=20[/tweet]

[M T]

How do we know to trust that reviewer more than the original author?  All we've been given in that tweet are 15 words.  They aren't engraved in a stone tablet brought down from the mountain.

(I happen to agree with those words, but that's not the point.)

I personally don't like all the tweets, often from self-appointed pundits, that we've been getting in this forum.  They are just institutionalized sound bites!

[M T]

How do we know to trust that reviewer more than the original author?  All we've been given in that tweet are 15 words.  They aren't engraved in a stone tablet brought down from the mountain.

(I happen to agree with those words, but that's not the point.)

I personally don't like all the tweets, often from self-appointed pundits, that we've been getting in this forum.  They are just institutionalized sound bites!

[2006alum]

How do we know to trust that reviewer more than the original author?  All we've been given in that tweet are 15 words.  They aren't engraved in a stone tablet brought down from the mountain.

(I happen to agree with those words, but that's not the point.)

I personally don't like all the tweets, often from self-appointed pundits, that we've been getting in this forum.  They are just institutionalized sound bites!

Read the underlying tweet it was referring to. It brings receipts, and seems to make some pretty legit criticisms to bear:
[tweet]https://twitter.com/llborio/status/1246051564307038211?s=20[/tweet]

[2006alum]

How do we know to trust that reviewer more than the original author?  All we've been given in that tweet are 15 words.  They aren't engraved in a stone tablet brought down from the mountain.

(I happen to agree with those words, but that's not the point.)

I personally don't like all the tweets, often from self-appointed pundits, that we've been getting in this forum.  They are just institutionalized sound bites!

Read the underlying tweet it was referring to. It brings receipts, and seems to make some pretty legit criticisms to bear:
[tweet]https://twitter.com/llborio/status/1246051564307038211?s=20[/tweet]

[dabigv13]

Hospitals, if they can get supply, have been using these medications for some patients. Anecdotally, it is not making a big clinical change. Some patients may benefit, some clearly don't, and we just don't have the studies to know if it's better than nothing, and exactly which patients most likely to benefit. All studies too small with plenty of methodology problems. This is from conversations from docs treating these patients. Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

[dabigv13]

Hospitals, if they can get supply, have been using these medications for some patients. Anecdotally, it is not making a big clinical change. Some patients may benefit, some clearly don't, and we just don't have the studies to know if it's better than nothing, and exactly which patients most likely to benefit. All studies too small with plenty of methodology problems. This is from conversations from docs treating these patients. Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

[M T]

 Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

Good luck & thank you!

[M T]

 Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

Good luck & thank you!

[BostonCard]

Hospitals, if they can get supply, have been using these medications for some patients. Anecdotally, it is not making a big clinical change. Some patients may benefit, some clearly don't, and we just don't have the studies to know if it's better than nothing, and exactly which patients most likely to benefit. All studies too small with plenty of methodology problems. This is from conversations from docs treating these patients. Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

At least you are an ENT (is that right?).  I will crap a brick when orthopods and pathologists are brought into the ICU.

BC

PS. thanks for pitching in.  Stay safe out there.

[BostonCard]

Hospitals, if they can get supply, have been using these medications for some patients. Anecdotally, it is not making a big clinical change. Some patients may benefit, some clearly don't, and we just don't have the studies to know if it's better than nothing, and exactly which patients most likely to benefit. All studies too small with plenty of methodology problems. This is from conversations from docs treating these patients. Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

At least you are an ENT (is that right?).  I will crap a brick when orthopods and pathologists are brought into the ICU.

BC

PS. thanks for pitching in.  Stay safe out there.

[2006alum]

Hospitals, if they can get supply, have been using these medications for some patients. Anecdotally, it is not making a big clinical change. Some patients may benefit, some clearly don't, and we just don't have the studies to know if it's better than nothing, and exactly which patients most likely to benefit. All studies too small with plenty of methodology problems. This is from conversations from docs treating these patients. Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

At least you are an ENT (is that right?).  I will crap a brick when orthopods and pathologists are brought into the ICU.

BC

PS. thanks for pitching in.  Stay safe out there.

+100. Here's hoping you stay safe, and thank you for your service.

[2006alum]

Hospitals, if they can get supply, have been using these medications for some patients. Anecdotally, it is not making a big clinical change. Some patients may benefit, some clearly don't, and we just don't have the studies to know if it's better than nothing, and exactly which patients most likely to benefit. All studies too small with plenty of methodology problems. This is from conversations from docs treating these patients. Looking likely I will be starting ICU rotations next week. Not an ICU doctor, but it's getting to be all hands.

Stay the ***** home.

At least you are an ENT (is that right?).  I will crap a brick when orthopods and pathologists are brought into the ICU.

BC

PS. thanks for pitching in.  Stay safe out there.

+100. Here's hoping you stay safe, and thank you for your service.

[dabigv13]

The orthopods are going to the ED/urgent care. Very quiet there still though, volume half as much as normal. ICU meanwhile approaching capacity.

Not sure where De Blasio thinks he's going to draft doctors from. This will hit all 50 states. And there are already plenty of older docs with comorbidities that are working. Same thing with NY state combing their resources and sending to where they are needed. It's good in theory. In practice I fear it means all the non-NYC locales will be out of vents and staff right as the surge comes for them, while NYC still has no end in sight. It's going to get really ugly this next month

[dabigv13]

The orthopods are going to the ED/urgent care. Very quiet there still though, volume half as much as normal. ICU meanwhile approaching capacity.

Not sure where De Blasio thinks he's going to draft doctors from. This will hit all 50 states. And there are already plenty of older docs with comorbidities that are working. Same thing with NY state combing their resources and sending to where they are needed. It's good in theory. In practice I fear it means all the non-NYC locales will be out of vents and staff right as the surge comes for them, while NYC still has no end in sight. It's going to get really ugly this next month

[BostonCard]

The orthopods are going to the ED/urgent care. Very quiet there still though, volume half as much as normal. ICU meanwhile approaching capacity.

Not sure where De Blasio thinks he's going to draft doctors from. This will hit all 50 states. And there are already plenty of older docs with comorbidities that are working. Same thing with NY state combing their resources and sending to where they are needed. It's good in theory. In practice I fear it means all the non-NYC locales will be out of vents and staff right as the surge comes for them, while NYC still has no end in sight. It's going to get really ugly this next month

Co-worker of mine still has her New York license.  She was invited back.  Another co-worker just left his ER/toxicology job, but his group asked him to serve as medical director for a makeshift (non-Covid) ER a few days a week.  So far they haven't been necessary with ER volumes down compared to normal, but they are as prepared as they can be. Another one is a former Kaiser ICU doctor, and he has been contributing shifts.  Volume there is below normal with no elective procedures, and the worst of the epidemic yet to hit.

I haven't been contacted yet (maybe that says something about my perceived clinical competence), but I have debated what, if anything to do if I'm needed when the wave crests.  At the same time, I'm involved in our Covid clinical trials, and we are trying to condense processes that normally take months into one week.

BC

[BostonCard]

The orthopods are going to the ED/urgent care. Very quiet there still though, volume half as much as normal. ICU meanwhile approaching capacity.

Not sure where De Blasio thinks he's going to draft doctors from. This will hit all 50 states. And there are already plenty of older docs with comorbidities that are working. Same thing with NY state combing their resources and sending to where they are needed. It's good in theory. In practice I fear it means all the non-NYC locales will be out of vents and staff right as the surge comes for them, while NYC still has no end in sight. It's going to get really ugly this next month

Co-worker of mine still has her New York license.  She was invited back.  Another co-worker just left his ER/toxicology job, but his group asked him to serve as medical director for a makeshift (non-Covid) ER a few days a week.  So far they haven't been necessary with ER volumes down compared to normal, but they are as prepared as they can be. Another one is a former Kaiser ICU doctor, and he has been contributing shifts.  Volume there is below normal with no elective procedures, and the worst of the epidemic yet to hit.

I haven't been contacted yet (maybe that says something about my perceived clinical competence), but I have debated what, if anything to do if I'm needed when the wave crests.  At the same time, I'm involved in our Covid clinical trials, and we are trying to condense processes that normally take months into one week.

BC

[dabigv13]

My dad is recently retired ENT, some hypertension, OSA etc. He wants to work if they need him. I told him no way, he needs to stay safe for my mom and her 90+ year old parents that live with them. He's very bored and useless feeling at the moment though so we'll see what happens. The most frightening thing to me is chance of bringing this home to my wife, daughter, or nanny. It looks like were ok on PPE so my tentative plan isn't to self isolate but instead wear a mask around my family and keep distance, and hope the worst passes soon. But if I'm doing a lot of shifts and worried about my exposure, may just live separately. It seems as long as you are using proper PPE, you can stay safe. Supposedly in Italy majority of infections of HCW was early before they had their guard up.

[dabigv13]

My dad is recently retired ENT, some hypertension, OSA etc. He wants to work if they need him. I told him no way, he needs to stay safe for my mom and her 90+ year old parents that live with them. He's very bored and useless feeling at the moment though so we'll see what happens. The most frightening thing to me is chance of bringing this home to my wife, daughter, or nanny. It looks like were ok on PPE so my tentative plan isn't to self isolate but instead wear a mask around my family and keep distance, and hope the worst passes soon. But if I'm doing a lot of shifts and worried about my exposure, may just live separately. It seems as long as you are using proper PPE, you can stay safe. Supposedly in Italy majority of infections of HCW was early before they had their guard up.

[magnus]

My dad is recently retired ENT, some hypertension, OSA etc. He wants to work if they need him. I told him no way, he needs to stay safe for my mom and her 90+ year old parents that live with them. He's very bored and useless feeling at the moment though so we'll see what happens. The most frightening thing to me is chance of bringing this home to my wife, daughter, or nanny. It looks like were ok on PPE so my tentative plan isn't to self isolate but instead wear a mask around my family and keep distance, and hope the worst passes soon. But if I'm doing a lot of shifts and worried about my exposure, may just live separately. It seems as long as you are using proper PPE, you can stay safe. Supposedly in Italy majority of infections of HCW was early before they had their guard up.

This may have been mentioned (perhaps by you) in one of these threads, but to decrease the chances, change out of your work clothes before you get into the car.  Leave your shoes out.  Shower when you get home.  And perhaps most importantly, figure out how to keep your phone from being exposed at work (zip lock bag?).  Some of my friends are also sleeping and showering in separate rooms.

As others have said, good luck, stay safe and thank you!

[magnus]

My dad is recently retired ENT, some hypertension, OSA etc. He wants to work if they need him. I told him no way, he needs to stay safe for my mom and her 90+ year old parents that live with them. He's very bored and useless feeling at the moment though so we'll see what happens. The most frightening thing to me is chance of bringing this home to my wife, daughter, or nanny. It looks like were ok on PPE so my tentative plan isn't to self isolate but instead wear a mask around my family and keep distance, and hope the worst passes soon. But if I'm doing a lot of shifts and worried about my exposure, may just live separately. It seems as long as you are using proper PPE, you can stay safe. Supposedly in Italy majority of infections of HCW was early before they had their guard up.

This may have been mentioned (perhaps by you) in one of these threads, but to decrease the chances, change out of your work clothes before you get into the car.  Leave your shoes out.  Shower when you get home.  And perhaps most importantly, figure out how to keep your phone from being exposed at work (zip lock bag?).  Some of my friends are also sleeping and showering in separate rooms.

As others have said, good luck, stay safe and thank you!

[BostonCard]

In a world with adequate PPE, one would wash hands, gown, glove, and mask before entering a patient's room, then doff the gown, glove, and mask and wash hands after seeing the patient and thus keep any contaminated material off your clothes.

Also, the whole purpose of hospital scrubs was to separate work and home clothes.  Now, traditionally scrubs were used to prevent clothes that may have gotten dirty outside the hospital from putting a patient at risk for infection, but it works the other way too.  Change into scrubs when you get to the hospital and change out of them before heading home to keep potentially contaminated scrubs out of your house.

BC

---

How do we know to trust that reviewer more than the original author?  All we've been given in that tweet are 15 words.  They aren't engraved in a stone tablet brought down from the mountain.

(I happen to agree with those words, but that's not the point.)

I personally don't like all the tweets, often from self-appointed pundits, that we've been getting in this forum.  They are just institutionalized sound bites!

More on the trial:

https://www.brief19.com/?utm_source=figu...gn=March25

Here's another tweet thread dumping on it:

https://twitter.com/lucasmorin_eolc/stat...9931155456

I think it is part and parcel of the scientific method for research to be subject to criticism.  Over time, a consensus will emerge, which will depend on multiple studies.  I wouldn't necessarily put more stock in the critique than the study, but rather in the accumulated evidence that is generated over time.

BC

[BostonCard]

In a world with adequate PPE, one would wash hands, gown, glove, and mask before entering a patient's room, then doff the gown, glove, and mask and wash hands after seeing the patient and thus keep any contaminated material off your clothes.

Also, the whole purpose of hospital scrubs was to separate work and home clothes.  Now, traditionally scrubs were used to prevent clothes that may have gotten dirty outside the hospital from putting a patient at risk for infection, but it works the other way too.  Change into scrubs when you get to the hospital and change out of them before heading home to keep potentially contaminated scrubs out of your house.

BC

---

How do we know to trust that reviewer more than the original author?  All we've been given in that tweet are 15 words.  They aren't engraved in a stone tablet brought down from the mountain.

(I happen to agree with those words, but that's not the point.)

I personally don't like all the tweets, often from self-appointed pundits, that we've been getting in this forum.  They are just institutionalized sound bites!

More on the trial:

https://www.brief19.com/?utm_source=figu...gn=March25

Here's another tweet thread dumping on it:

https://twitter.com/lucasmorin_eolc/stat...9931155456

I think it is part and parcel of the scientific method for research to be subject to criticism.  Over time, a consensus will emerge, which will depend on multiple studies.  I wouldn't necessarily put more stock in the critique than the study, but rather in the accumulated evidence that is generated over time.

BC

[magnus]

Here's another doctor using hydroxycloroquine, but with doxycycline instead of azithromycin to minimize adverse heart reactions. 

https://nypost.com/2020/04/04/long-islan...-patients/

About 80% recovered without hospitalization which seems like a good percentage when considering he was treating a nursing home.   I don't know the exact stats for the elderly but it's worse than the population wide 20% hospitalized rate that gets thrown around. 

Hopefully we hear more positive stories like this.

[magnus]

Here's another doctor using hydroxycloroquine, but with doxycycline instead of azithromycin to minimize adverse heart reactions. 

https://nypost.com/2020/04/04/long-islan...-patients/

About 80% recovered without hospitalization which seems like a good percentage when considering he was treating a nursing home.   I don't know the exact stats for the elderly but it's worse than the population wide 20% hospitalized rate that gets thrown around. 

Hopefully we hear more positive stories like this.

[BostonCard]

Even within the administration there's debate about chloroquine.

https://apple.news/ApJ6pmK2ESNS-E9eHUODe7A

BC

[BostonCard]

Even within the administration there's debate about chloroquine.

https://apple.news/ApJ6pmK2ESNS-E9eHUODe7A

BC

[fullmetal]

I don't understand how an economic adviser thinks he has the standing to argue about clinical efficacy of an unproven drug treatment with a leading CDC scientist.  Dunning-Kruger...

Anyway, if there were a miracle drug out there, Italy would have stopped their body count a long time ago.  They've lost a lot of people, and I'm certain there's nothing they wouldn't have tried if it worked.  Same goes for Vitamin C, which is making the rounds as a miracle cure in certain corners of facebook these days.

dabigV, you take care of yourself.

[fullmetal]

I don't understand how an economic adviser thinks he has the standing to argue about clinical efficacy of an unproven drug treatment with a leading CDC scientist.  Dunning-Kruger...

Anyway, if there were a miracle drug out there, Italy would have stopped their body count a long time ago.  They've lost a lot of people, and I'm certain there's nothing they wouldn't have tried if it worked.  Same goes for Vitamin C, which is making the rounds as a miracle cure in certain corners of facebook these days.

dabigV, you take care of yourself.

[BostonCard]

For the next ghostbusters movie, the tagline will be "Back off man, I'm a social scientist!"

https://www.cnn.com/2020/04/06/politics/...index.html

To be fair to Navarro, some of the skills, such as being able to understand statistics and strengths and weaknesses of studies, are transferable.  And he is correct that doctors disagree all the time, even about this.

But this seems like a textbook example of motivated reasoning.  Under normal circumstances, there is no way that most physicians would accept this level of evidence in order to adopt a therapy.  But these are not normal circumstances and in the lack of any alternative therapies and in the face of high mortality, it is reasonable to try the therapy.  But, and this is an important but, there is a difference between that and declaring the drug a "game changer" on the basis of this limited evidence.  Even someone who is hopeful that the drug should work, ought to be calling for more data and more robust studies.

BC

[BostonCard]

For the next ghostbusters movie, the tagline will be "Back off man, I'm a social scientist!"

https://www.cnn.com/2020/04/06/politics/...index.html

To be fair to Navarro, some of the skills, such as being able to understand statistics and strengths and weaknesses of studies, are transferable.  And he is correct that doctors disagree all the time, even about this.

But this seems like a textbook example of motivated reasoning.  Under normal circumstances, there is no way that most physicians would accept this level of evidence in order to adopt a therapy.  But these are not normal circumstances and in the lack of any alternative therapies and in the face of high mortality, it is reasonable to try the therapy.  But, and this is an important but, there is a difference between that and declaring the drug a "game changer" on the basis of this limited evidence.  Even someone who is hopeful that the drug should work, ought to be calling for more data and more robust studies.

BC