
About that Hydroxychloroquine for Covid-19 trial - hannob
https://betterscience.org/archives/11-About-that-Hydroxychloroquine-for-COVID-19-trial.html
======
ekianjo
Criticism on study design during an emergency is fine, but still, we are not
talking about some marginal level of efficacy here:

[https://www.medrxiv.org/content/10.1101/2020.03.16.20037135v...](https://www.medrxiv.org/content/10.1101/2020.03.16.20037135v1.full.pdf+html)

> The proportion of patients that had negative PCR results in nasopharyngeal
> samples significantly differed between treated patients and controls at days
> 3-4-5 and 6 post-inclusion (Table 2). At day6 post-inclusion, 70% of
> hydroxychloroquine-treated patients were virologicaly cured comparing with
> 12.5% in the control group (p= 0.001).

The effect size is huge, even considering the potential biases.

~~~
fabian2k
One of the issues with the study is that they didn't use the clinical outcome
as an endpoint, they just measured the virus concentration in the throat (and
even that not properly for all cases as far as this HN post says).

Huge effect size doesn't matter at all when the effect is not the correct one.
There is a significant risk that this surrogate endpoint is not telling the
true story as the virus migrates to the lung, measuring in the throat could be
very misleading.

~~~
ekianjo
Is there a reason to believe the viral load in the throat and the lungs would
not follow the same trend? And you also forget to mention this (CQ and HCQ
concentrate in certain organs):

> It has been reported that oral absorption of CQ and HCQ in humans is very
> efficient. In animals, both drugs share similar tissue distribution
> patterns, with high concentrations in the liver, spleen, kidney, and lung
> reaching levels of 200–700 times higher than those in the plasma10. It was
> reported that safe dosage (6–6.5 mg/kg per day) of HCQ sulfate could
> generate serum levels of 1.4–1.5 μM in humans11. Therefore, with a safe
> dosage, HCQ concentration in the above tissues is likely to be achieved to
> inhibit SARS-CoV-2 infection.

[https://www.nature.com/articles/s41421-020-0156-0](https://www.nature.com/articles/s41421-020-0156-0)

~~~
fabian2k
Yes, that's one aspect discussed in the podcast with Christian Drosten that is
linked in the blog post. This is the relevant part:

> We have a lot of experience. We have made the most precise description of an
> untreated patient cohort among the Munich patients. And at the Munich group,
> we saw how the virus concentration in both the throat and lungs behaved over
> time. And we can say that at the beginning of the disease the virus is in
> the throat and it goes away on its own through the - let's say - the first
> ten days of the disease. After that, many patients in the throat have little
> or only irregular evidence of the virus.

But that has nothing to do with how the virus behaves in the lungs. The virus
is then really replicative in the lungs, especially in severe cases. And we
can also say what the patient has in his throat, it has nothing to do with how
the clinical development of the disease continues, whether the patient quickly
gets well or only goes through a difficult phase. So what is being measured in
this entire clinical study has nothing to do with the outcome of the disease,
with the symptoms, but is only an initial indicator of how the disease starts.
For all patients, the virus concentration drops in the first week, but if you
now imagine that the group being treated will be included a little later and
the untreated group being included earlier in this study, it is in nature the
thing that with this group that was later included - they are already further
in eliminating the virus from the throat - that the virus then goes down in
the throat, faster. This disappears faster because they have simply been in
the course of the disease for a long time. Whether this is due to the fact
that they are treated, cannot be said at all from this entire study. Perhaps
it would have been so if the groups had been put together as here, but if they
hadn't given them chloroquine, but some headache pill, the study would have
been the same.

------
roenxi
Why are we so excited about the French trial? What about the Chinese treatment
guidelines [0]?

The Chinese recommend chloroquine phosphate. They've had more experience than
anyone else in this area and have had time to conduct actual trials. The
disease has a ~2-4 week course so it should take about that long to gather
compelling evidence; and they've been dealing with it since January.

The French are clever people, but we really should be looking to Asia for this
information. People should be finding and quoting Chinese studies.

[0]
[http://kjfy.meetingchina.org/msite/news/show/cn/3337.html](http://kjfy.meetingchina.org/msite/news/show/cn/3337.html)
10(b)(4)

~~~
klmadfejno
The featured article claims that references to the supposed Chinese studies
don't turn up anything. And that seems to be true. Here is the Chinese cited
material from the French article:
[https://www.jstage.jst.go.jp/article/bst/14/1/14_2020.01047/...](https://www.jstage.jst.go.jp/article/bst/14/1/14_2020.01047/_article)

It claims many clinical trials have been done in China that show chloroquine
works. However... there's nothing to actually read with any data.

------
lez
Another anti-malaria drug, methylene blue had been proven to work against
coronavirus in blood plasma in 2005 [1].

It is used in photodynamic therapy to selectively kill some viruses (see
below) / bacteria (e.g. mycoplasma) [2].

When entering the bloodstream, it binds selectively to the nucleus of the
viruses it is effective against. It's the same mechanism why it's effective as
a dye to stain microbes under microscope. Methylene blue best absorbs light at
660nm wavelength, which at the same time penetrates into human tissues deeply.
When light is absorbed, methylene blue disintegrates to harmless molecules
while releasing reactive oxygene species, killing the virus.

It is a very safe drug, so the same logic that bsaul mentioned could be
applied, and therefore would be a responsible move. It is also beneficial to
mitochondria and effective against fungus.

[1]
[https://europepmc.org/article/cba/518857](https://europepmc.org/article/cba/518857)
[2]
[https://www.sciencedirect.com/science/article/abs/pii/S15721...](https://www.sciencedirect.com/science/article/abs/pii/S1572100005000979)

~~~
hprotagonist
it also literally turns your bodily emissions blue, needs to be administered
intravenously, and has some ugly side effects:

 _Common side effects include headache, vomiting, confusion, shortness of
breath, and high blood pressure.[1] Other side effects include serotonin
syndrome, red blood cell breakdown, and allergic reactions.[1] Use often turns
the urine, sweat, and stool blue to green in color.[3]_

~~~
lez
These side effects occur in extremely high doses, much much higher than the
effective dosage.

It doesn't need to be administered intravenously (only for methemoglobenia) -
although more effective that way.

serotonin syndrome, rbc breakdown and allergic reactions occur when you drink
a glass of what few drops are enough.

As said, it is extremely safe drug in low dosages (4-16 drops of 0.1%
solution).

Edit: Also see the Kevin Rose Show episode [https://podcast.kevinrose.com/dr-
peter-attia-longevity-compo...](https://podcast.kevinrose.com/dr-peter-attia-
longevity-compounds-fasting-supplements-and-more) starting @ 1:16:20

------
axguscbklp
The numerous* stories that I have read recently about medical professionals
writing themselves prescriptions for hydroxychloroquine so that they can have
it available for themselves and their families suggests to me that the French
trial is not the only reason to be hopeful about hydroxychloroquine's efficacy
against COVID-19.

Sure, medical professionals are not necessarily any kind of super-rational
savants, but I think it's unlikely that all of the medical professionals who
are trying to hoard hydroxychloroquine are being irrational hysterics. They
might be engaging in ethically questionable acts by hoarding
hydroxychloroquine, but that doesn't mean that they don't know what they're
doing from a self-preservation standpoint.

That said, it's not that I think they are necessarily trying to hoard
hydroxychloroquine because they are convinced that it works - it's probably
more that they want it on hand in case it turns out that it works. However,
some of them may also have directly seen it help people, or may have heard or
read about it helping.

Given that hydroxychloroquine has already been used for, as I understand it,
weeks in treating people ill with COVID-19, I am actually surprised that there
is not more anecdotal evidence about its efficacy. But I probably have just
not been reading in the right places.

*Edit: I probably shouldn't have said "numerous stories", since "numerous" implies more than the number that I actually have seen.

~~~
Obi_Juan_Kenobi
The vast majority of medical professionals are not researchers, and are not
trained in evaluating clinical trial data. They are notoriously poor at
assessing such information.

You can be a remarkable clinician without ever interacting with the primary
literature. These are simply different things.

~~~
ExtremisAndy
> The vast majority of medical professionals are not researchers, and are not
> trained in evaluating clinical trial data. They are notoriously poor at
> assessing such information.

Citation, please. This is a very strong statement.

~~~
refurb
As someone who works in drug development, this is very accurate.

Understanding, designing and executing clinical trials is an entire specialty
within medicine. Your average doctor will be familiar with the concepts, but
not necessarily adept at evaluating a clinical trial.

------
bsaul
I see many problems with all the caution around that study:

1/ chloroquine is a very well known cheap drug. There is no new risk
associated to using it that doctors arent already aware of.

2/ we do have a lot of statistics now on the outcome of patient _not_ treated
with that drug. There's no need for establishing a benchmark. Just proper
categorization of existing patient should be enough to compare.

3/ people are oversaturating ICU _right now_. And as such, it _is_ an
emergency situation. We should take the reverse reasoning we usually take : if
there's no suscipicion this drug could cause new problems, we should have
people massively use it whenever possible and look at the result after 6 days
(since that's the time the original study says it takes for the first results
to show).

~~~
jonathanstrange
This is irresponsible. This drug has _severe_ side effects, it makes
absolutely no sense to prescribe it for a completely different disease without
first confirming in clinical trials that it has positive effects.

> _if there 's no suscipicion this drug could cause new problems, we should
> have people massively use it_

That's not how evidence-based medicine works. The drug is _known_ to cause new
problems because of the side effects. Clinical trials are needed to determine
whether these are outweighed in patients by positive health effects.

You do not prescribe medicine on the basis of hunches.

~~~
ekianjo
> This is irresponsible. This drug has severe side effects

What are you talking about? The severe side effects are known and are usually
associated with chronic usage of that drug. Chloroquine is taken for
prophylaxis against malaria (daily) in many places in the southern hemisphere.
Usual regimen is at least for 8 continuous weeks!

EDIT: Toxicity here: as you can see it's very well tolerated.
[https://eyewiki.aao.org/Hydroxychloroquine_toxicity](https://eyewiki.aao.org/Hydroxychloroquine_toxicity)

~~~
jonathanstrange
The suggestion on the table is to give this drug to extremely ill patients who
suffer from a new viral disease on the basis of anecdotal evidence and without
clinical trials. The suggestion was to massively prescribe it.

What health authorities want to do is to _allow_ physicians to use the drug if
the patient agrees, but only in a controlled setting in which data is
collected and there is a control group. So at least afterwards we could draw
conclusions about whether it killed more people or helped saving people. Does
that not make sense to you?

~~~
bluecalm
As noted in the original post you replied to we don't really need a control
group because we already have a lot of experience with people who didn't get
any drugs. Quoting that post: "all that is needed is a proper categorization".

The goal here is to get enough evidence the treatment works or doesn't work.
Conducting double blind studies is not the most efficient and fastest way to
do that when you already have a lot of preexisting knowledge about both the
patients not receiving any drugs and the safety profile of the drug in
question.

This is again a situation where statisticians should be asked for help as
medical professionals very often operate on very simplistic model (double
blind or gtfo) which we just don't have time for this time around.

~~~
IAmEveryone
We have far more experience with AIDS, or heart attacks, or hair loss, or
really any disease.

And yet trials for new medication against these diseases always include a
control group.

~~~
bluecalm
Yeah because it's not urgent and it's a clean understood protocol. It's
absolutely not optimal if your goal is to get to enough confidence fast.

------
emilsedgh
I have 0 clues about clinical trials and the procedures. My questions is: Why
are so few studies done on this?

I think so far we have 2 studies. (from China and France).

However, we've had hundreds of hospitals around the world with thousands of
patients. And the drug is cheaply available.

What is preventing us to have studies around this in tens of different
hospitals? Wouldn't WHO be able to budget this, or actually send people to
conduct these studies all across the globe and report back day to day, so
within 2 weeks we get a pretty significant set of data?

~~~
chasil
This drug has actually been mentioned in several past clinical studies on the
closely-related SARS. The particular study below has been circulating in
several areas online, and has citations to several more:

[https://cmr.asm.org/content/20/4/660.long](https://cmr.asm.org/content/20/4/660.long)

Despite the role of the pH-sensitive endosomal protease cathepsin L in the
entry pathway (151, 300), viral culture does not require pretreatment with
trypsin. However, this pH-sensitive cathepsin L may be a target for agents
such as chloroquine, which elevates endosomal pH (174, 341).

~~~
hanniabu
I'm sure I'm not the only one wondering this..... what does this mean in
layman's terms?

~~~
treis
The chemical pathway that allows the virus to enter the cell changes based on
the pH of the cell. Chloroquine changes the pH of that pathway and therefore
may slow/stop the entry of the virus into the cell.

------
jansan
I have a question about this article published in The Lancet:

[https://www.thelancet.com/journals/lancet/article/PIIS2213-2...](https://www.thelancet.com/journals/lancet/article/PIIS2213-2600\(20\)30076-X/fulltext)

Looking at the drug cocktail that the patient received, this seems to be
pretty heavy artillery:

\- methylprednisolone

\- moxifloxacin

\- lopinavir plus ritonavir

\- interferon

\- meropenem

Holy shit, is this a recommended medication for severe Covid-19 cases?

~~~
Cantbekhan
It seems this man was treated with lopinavir–ritonavir ... Unfortunately
according to this recently published study, it seems inefficient against
Covid19.

[https://www.nejm.org/doi/full/10.1056/NEJMoa2001282?query=fe...](https://www.nejm.org/doi/full/10.1056/NEJMoa2001282?query=featured_home)

It also seems some EU countries are now stopping the use of lopinavir due to
this study.

~~~
jansan
I found this "Some centers and even national guidelines, such as those in
Italy, have recommended treatment with lopinavir-ritonavir for patients with
COVID-19 infection."

Not sure what to make of this. Can this to some extent explain the huge
differences in death rate between Italy and Germany?

Source:
[https://www.medpagetoday.com/infectiousdisease/covid19/85499](https://www.medpagetoday.com/infectiousdisease/covid19/85499)

~~~
Cantbekhan
As far as the netherlands are concerned, Lopinavir is now removed from their
interim guidelines. The first line treatement is now
hydroxichloroquine/chloroquine with maybe remdesivir for severe cases.

Source (in Dutch): [https://swab.nl/nl/covid-19](https://swab.nl/nl/covid-19)

But yes in Italy the current guidelines (which are still dated 13 February
still mention lopinavir).

Source (in Italian):
[http://www.simit.org/medias/1569-covid19-vademecum-13-03-202...](http://www.simit.org/medias/1569-covid19-vademecum-13-03-202.pdf)

It has also been removed from guidelines from Belgium: source (English) :
[https://epidemio.wiv-
isp.be/ID/Documents/Covid19/COVID-19_In...](https://epidemio.wiv-
isp.be/ID/Documents/Covid19/COVID-19_InterimGuidelines_Treatment_ENG.pdf)

I think the odd case is France wich I think is still not having
Chloroquine/Hydroxichloroquine in their guidelines as of today.

I was not able to find the german guidelines.

~~~
hanniabu
Hopefully they're documenting their results with chloroquine to help have a
better understanding.

------
biolurker1
I like facts. Article says only French study exists but at least a couple of
other studies exist from China. I wish when someone makes a very important
argument to check all internet sources.

------
MisterBastahrd
[https://nypost.com/2020/03/19/sales-of-fish-tank-additive-
sk...](https://nypost.com/2020/03/19/sales-of-fish-tank-additive-skyrocket-
after-studies-say-it-could-treat-coronavirus/)

This is the kind of idiocy that pie-in-the-sky theatrical crap like this
causes. People are going to end up seriously harming if not killing themselves
by taking this stuff.

------
jeffdavis
It seems like the answer is "more science".

Given how the virus is moving now, couldn't we have a pretty nice study
completed in a few weeks?

------
Bhilai
Related: Novartis commits to donate up to 130 million doses of
hydroxychloroquine

[https://www.novartis.com/news/media-releases/novartis-
commit...](https://www.novartis.com/news/media-releases/novartis-commits-
donate-130-million-doses-hydroxychloroquine-support-global-covid-19-pandemic-
response)

------
DocSavage
Regarding randomization, the HCQ + Azithromycin study showed good results
despite the control group being 14 years younger. Sex was about equal so no
male/female imbalance. It’s clear that older patients have worse outcomes, but
this study measures viral load which also can change depending on the stage of
the disease.

~~~
cycrutchfield
There were 6 patients in that group. No mention of how they were selected.
Some patients dropped out of the treatment group because they died or went to
the ICU. These could affect the numbers significantly.

------
Cantbekhan
If you are curious, this is the actual Chinese trial registration (edit: not
results) about hydroxichloroquine (among the many citations in the pdf)

[http://www.chictr.org.cn/showprojen.aspx?proj=48880](http://www.chictr.org.cn/showprojen.aspx?proj=48880)

~~~
chvid
Is this an ongoing trial? When are the results due? 3x100 subjects (is that
correctly read?) seems quite powerful.

~~~
Cantbekhan
Yes it seems they have 100 on one dosage, 100 one a different dosage and 100
in a placebo group.

According to the register, the study execution time should be "2020-01-31 To
2020-02-29"

But nobody seems to have any insight on the final results. But I would
recommend this article with comments of the study leader (Dr Zhang Zhan). The
article also explains how they initially discovered the efficiency of the drug
by just noticing there were no lupus patients (who were under chronic
treatment of hydroxichloroquine) infected with covid19.

[https://www.jqknews.com/news/388543-The_novel_coronavirus_pn...](https://www.jqknews.com/news/388543-The_novel_coronavirus_pneumonia_has_short_term_curative_effect_on_the_treatment_of_new_crown_pneumonia.html)

~~~
hanniabu
> But nobody seems to have any insight on the final results.

I assume that means it's either too small of a sample size or it doesn't make
enough of an affect?

~~~
zeckalpha
A study designed like this shouldn’t have data analysis before it is all
collected.

------
sanxiyn
Favipiravir trial result is out and the result looks good:
[https://www.medrxiv.org/content/10.1101/2020.03.17.20037432v...](https://www.medrxiv.org/content/10.1101/2020.03.17.20037432v1)

~~~
deskamess
The world needs something that is accessible.

"As of 23 March 2020, it seems that Japan and China have issued an export ban
on the substance. Japan and China are the only countries in which favirapir is
produced and approved as a medical compound." [1]

[1]
[https://en.wikipedia.org/wiki/Favipiravir](https://en.wikipedia.org/wiki/Favipiravir)

~~~
dx034
And I guess setting up factories to produce millions of doses of new meds can
take a while. At the same time, each new manufacturer has to negotiate terms
with the patent holder. Using an existing cheap generic drug means that
production facilities are already up and running and that any company could
start if they have the means to produce it.

Apparently a 1-month dose costs £5 in the UK, so there doesn't seem to be a
large hurdle to produce it.

~~~
owl57
Do governments have a good reason not to suspend patents for the time of
emergency? Emergency rules break a lot of other businesses, and pharma is
probably one of the few industries not in danger?

~~~
JNRowe
When thinking about this I always assume it is the same reason countries
tended not to reach for national security provisions¹ despite how attractive
they are, it just isn't clear how to put the genie back in the bottle when
you've broken it with the biggest-and-most-crushy hammer you can find.

If you dig around in the other exceptions in the document I've linked you'll
see there are multiple places where patent protection and protection of human
life are discussed.

I know where I sit on the patent validity continuum already, but I also know
other people are furiously bouncing on the other end of that seesaw.

1\.
[https://www.wto.org/english/docs_e/legal_e/gatt47_02_e.htm#a...](https://www.wto.org/english/docs_e/legal_e/gatt47_02_e.htm#articleXXI)

------
max_
Chloroquine was banned years ago in my country due to its toxic effects (was
making kids deaf amongst other things).

Are its downsides worth the upsides when used as a COVID-19 treatment?

~~~
Zak
The course of treatment is short, while some applications of chloroquine are
long-term. The risk is likely considerably reduced.

------
Avshalom
[https://thehill.com/policy/healthcare/489097-man-dies-
after-...](https://thehill.com/policy/healthcare/489097-man-dies-after-taking-
malaria-medication-in-effort-to-prevent-coronavirus)

well that took what, two days?

------
ekianjo
> I don't see how doing poorly performed studys that tell us nothing is of any
> help.

Erm, even poorly designed studies tell you if there's any efficacy to expect
or not. And it leads to better studies afterwards.

Science is iterative.

~~~
_ph_
I am not a doctor, just a physicist, so I know about experimental data, but of
course not about this study in detail. But as several sources dealing with
this study confirm, it doesn't really tell us anything. So really at best it
can be seen as reason to conduct a proper study, but the data itself does not
yield any conclusion.

~~~
ekianjo
There's a lot in medicine that goes into publication that has results not even
borderline as meaningful as this. I would be careful to label this as "it
doesn't really tell us anything". Especially since another study in China
reached a similar conclusion.

~~~
davrosthedalek
a) The quality, or lack of quality, of other studies does not affect the
quality of the discussed study. b) The availability of another study with
similar results, does not affect the quality of this study.

------
vsmhn
Also on HN: [https://www.sciencemag.org/news/2020/03/who-launches-
global-...](https://www.sciencemag.org/news/2020/03/who-launches-global-
megatrial-four-most-promising-coronavirus-treatments)

Testing will be randomized apparently.

~~~
ncmncm
Maybe change the link in the header?

------
klmadfejno
A lot of people are eager to say chloroquine is the answer and say, "forget
the small details, look at that p-value!". But this article raises a bunch of
important points. The important ones IMO are:

1) 6 / 26 of the individuals in the experimental group got removed from the
stats because their condition got worse and the treatment ceased. One of them
died.

2) The metric used to test the efficacy is viral load. You can get a negative
on this and still have the disease. This is going to be a function of how long
you've had the disease, which isn't controlled in the study.

If you have a gripe with the author because they're not a medical scientist,
read the peer review comments here:
[https://pubpeer.com/publications/B4044A446F35DF81789F6F20F8E...](https://pubpeer.com/publications/B4044A446F35DF81789F6F20F8E0EE#2)

They are easy to understand as a layman I feel.

Other noteworthy takeaways:

1) The combination of HCQ and AZ was hyped as superior because all 6 patients
did better. But looking at the data there is no significant difference in
viral load outcomes between both drugs and just HCQ.

2) Many of the author's claims of statistical significance disappear if you
use more conservative estimates for when people were supposed to be PCR
positive except for Day 6 (now 0.01 instead of 0.001).

3) The paper turnaround was incredibly fast, with less than 24 hours for peer
review. One of the authors of the paper is an editor of the journal in which
it was published. Could be indicative of poor study controls.

I hope this turns out to be useful. I would not be surprised if it did not.
Regardless, the best case takeaway of THIS information does not inform us
about how the drug performs in the most critical area (severe ICU patients).

If you're a non-bio programmer please try to recognize that saying the current
paper is good enough to justify mass distribution of chloroquine tablets to
everyone is about on par with the cliche clueless product manager making bold
decisions about how to move forward with your codebase despite having no clue
how it works themselves.

------
stevespang
Here we go, another naysayer.

Unfortunately, all those waiting patiently for "confirmed results of double
blind trials" will make up a significant percentage of those visiting the
pearly gates by the time those trials are ever completed.

Look, the risk is fairly low for chloroquine, mild side effects in a very well
done Danish study were only ~15%, serious side effects were ~1.5%.

Reported Side Effects to Chloroquine, Chloroquine plus ... academic.oup.com ›
jtm › article-pdf › jtm7-0079

Now, what's the risk of serious side effects/death from coronavirus for those
over 70 years old ? Like >10%.

And a recent report out of Hong Kong is stating that lung scarring from
coronavirus is being found in all ages (radiological imaging), like 20 to 30%
loss of lung function, shortness of breath reported by recovered patients just
from fast walking - - - is that going to be permanent in all ages ? Are you
willing to take that risk ?

A glaring fact is that chloroquine / hydroxychloroquine have been on the WHO's
list of essential medicines for decades . . . . why so, if they were too toxic
to recommend ?

Just like the rush on buying ammo, would you prefer to have "the likely
treatment" before the problems comes to you - - or, would you prefer to fail
to find it after all the shops and stores are completely sold out and the
unemployed "zombies" are all over your property and smashing down your door
while your family is cowering under the table screaming and crying for help ?
I already got my supply of it, best of luck for all the naysayers.

[https://www.foxnews.com/health/florida-man-with-
coronavirus-...](https://www.foxnews.com/health/florida-man-with-coronavirus-
claims-malaria-drug-saved-life)

[https://video.foxnews.com/v/6143849011001](https://video.foxnews.com/v/6143849011001)

BTW, what is your Gov't offering you right now in the way of proven drugs ?
Nothing. All the while the rich in NY are reported in the news media as
cashing in on favors to secure reservations for hospital beds in case they
need them - - and buying ventilators . . . under the counter.

------
KillerRAK
Nothing quite like a site titled "Better Science" with the disclaimer:

"While I understand the basics of a clinical trial, I’d like to point out that
I am no medical scientists. Most of the issues here were spotted by other
people and I have linked to the sources."

You cannot make this s@#t up!

Put on your critical thinking caps folks -- there's a lot of bad info out
there.

~~~
lanewinfield
As soon as I read that line, I closed the window. Not worth it.

~~~
jstanley
Why? I'd rather get information from a humble expert from a different field
than from a braggart who thinks they're an expert.

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gyrgtyn
why is every study i've ever seen posted somewhere deeply flawed -in some way
that is obvious to even non-experts?

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thdespou
I've read that 2g of this drug can kill you.

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Mountain_Skies
So can 10g of caffeine. As a result, caffeine isn't distributed in ten gram
doses.

