This study always smelled bad. The media was so quick to champion it everywhere though. Why might that be I wonder? Where are the retractions now? The whole thing is disgusting.
The media in the US is doing everyone a disservice. Because of this less people are going to believe "science" and more people are going to just retreat to their echo chambers and believe whatever they want. I know I'm not going to trust the Lancet or the NEJM ever again. It's all political now.
What a mess.
COVID patients are different from the patients that normally receive chloroquine and the chloroquine doses used for COVID are also higher. There is also the issue of how chloroquine interacts with other drugs such as azythromycin.
This particular study has its problems but other studies on chloroquine were also starting to suggest that chloroquine could have dangerous side effects.
Aspirin is one of the most widely used drugs and generally considered safe. But you should never give it to a kid with chickenpox, because doing so is a risk factor for developing Reye's Syndrome, a serious and potentially fatal disease.
It's not that aspirin "becomes more dangerous" in general, but it is more dangerous for those particular patients. And we don't really know why, either; but the data is clear on the correlation.
We don't yet know all the ways that the novel coronavirus makes people sick. Heck we don't even have a reliable inventory of possible symptoms yet.
So it's really not fair to pretend that it would be silly or unreasonable to suspect the possibility of some sort of negative correlation with a particular drug or class of drugs. This sort of thing happens all the time in medicine.
This is a dangerous view and not a fair take. Drugs CAN become more dangerous when used in a different context. The sheer permutation of prior/current medical conditions, interacting drugs, demographics, genetics, medical procedures, and a bunch of other factors all play into the equation that determines a drug's safety and efficacy profile. This is why we continue to do research. This is why guidelines are constantly shifting. This is why medicine requires years of study.
> The media was so quick to champion it everywhere though.
I definitely agree with this point. The media has caused harm to the population by taking the results of a single observational study, and parading it around like it was some new concrete medical certainty. This is not how professionals operate. We don't flip our practice on the whims of a single OBSERVATIONAL study.
And I emphasize OBSERVATIONAL because most people here don't understand what that entails. Most people here who comment on clinical trials are not even trained to interpret them. Is it randomized/non-randomized? Double-blinded? What did data collection look like? How were results analyzed? What was the patient population? Timelines? Control arm? Placebos? Previous findings? Primary/secondary endpoint? Do you know the difference between a meta-analysis and a systematic review? NNT? Hazards ratios? Odds ratios?
Too many people outside of medicine think they know how to interpret a study, when in reality they have no idea what they're looking at and cherry-pick the interesting sentences that they're looking for.
> I know I'm not going to trust the Lancet or the NEJM ever again.
This is not a fair take. The journals are responsible for reviewing and publishing the most influential clinical research in the world. Occasionally a bad study makes its way in due to falsified data or other illegitimate factors. Health care professionals are well-aware of this, which is why we are trained to interpret studies, and be conservative in the face of radical findings like this.
If anyone has a problem with the Lancet or NEJM, they should see some of the mess found in lower-impact journals.
The lesson I learned is that I will always scrutinize papers I read with a more critical eye, regardless of where they were published in.
a) a grammar/spelling check
b) a gut check to make sure it "makes sense"
c) validation of the math/analysis
d) validation of the underlying experimental procedure used to collect the data
e) validation of the underlying selection criteria for inputs/candidates in the experiment
f) reproducibility of the experiment and results
g) something else?
h) all of the above
My impression is that "peer review" generally includes a & b and sometimes c & d.
The fact that the lancet was able to determine that there were validity concerns with the data and issue an expression of concern in less than 2 weeks is proof that the system works.
Science is never 100% certain. The media has never been a good source of scientific information and probably never will be.
edit: also, if you "don't trust the Lancet or NEJM" then you don't trust a huge number of the treatments available to you at the hospital. These are two of the most important and eminent medical journals in the world and many life-saving treatments began as articles in these journals.
It is later when other scientists start working to replicate or expand on the study that they request access to the data, and dig into the details. This is when most instances of scientific misconduct are found, and this paper is no exception.
In science, publication is the start of the peer review process, not the end.
I was quite surprised at the newfound fatality. Given that it was the Lancet, I took it at face value. Their political biases made them overlook the sheer flimsiness of the study.
Rather than a mess, it is showing us the messy humans behind the veil of "science". There is no platonic scientist - just humans doing imperfect science.
Aspirin has a long track record and well understood safety profile, but it can still cause life threatening complications like Reye syndrome in certain viral infections.
He also quotes the CDC website saying it is quite safe.
> “CDC has no limits on the use of hydroxychloroquine for the prevention of malaria. When hydroxychloroquine is used at higher doses for many years, a rare eye condition called retinopathy has occurred. People who take hydroxychloroquine for more than five years should get regular eye exams.”
I guess this way at least they can point the responsibility somewhere else, and say it's not their fault.
On top of that, there is no patent money to be made by big pharmaceuticals on this drug. It makes me wonder where the funding really came from in this Lancet study.
The next fiasco-in-the-making to watch is the 'evidence-based' criminal justice reform sure to come to a lot more American cities soon.
You're throwing around an awful lot of poo. Nothing concrete at all but all in very emotive terms. Not constructive - but was that the point?
 (note scare quotes)
I’m all for being skeptical, but I think they went overboard, especially given the alternative of having no medicine.
When an existing drug is intended to treat some new disease it needs to be reevaluated for that disease again, because even if it can save lives for one disease it can be deadly for another.
So the fact that it is given to thousands or millions does not mean much in this context.
That's true. There are people who want to discredit science as a whole. Reality tends to get in the way of most hidden agendas - that's why they're hidden.
Because our president was idiotically and irresponsibly championing a drug for which there was no good evidence of efficacy at all.
This is an absurd reaction and I suspect you know it. There isn't a single scientific journal in the world not subject to some bias, trend, or failure of one form or another. To dismiss an entire platform because of an imperfect record amounts to an abdication of your own responsibility to form your own opinions about scientific matters. This is a responsibility for which journal reviewers can only ever take partial responsibility for both practical and intrinsic reasons.
Peer review is not a rubber stamp which blesses anything which passes through it as "TRUTH." It is a minimal standard and subject, at any rate, to all the uncertainties and biases implicit in any human endeavor. It is entirely possible this paper represents a political bias. Almost everything does. It still falls to us to make reasonable judgments about science. What doesn't make sense is to reject the entire process because it fails to meet some unreachable expectation of perfection.
Can you provide examples? I'm sure it'll be hard, if not impossible, to provide an example that's as emotionally satisfying as directly contradicting Trump, but I'd love to see which studies you're thinking of.
Don't forget, The Lancet is also the journal which published the paper that kicked off the anti-vax movement: https://en.wikipedia.org/wiki/Lancet_MMR_autism_fraud
> ACE2 can also be increased by thiazolidinediones and ibuprofen.
The closest thing I could find  to a source for that was :
> NSAIDs [Non-Steroidal Anti-inflammatory Drugs, which includes ibuprofen] might affect how Covid-19 binds to human cells, according to Dr. Yogen Kanthi, assistant professor of cardiology at the University of Michigan, who studies inflammation.
> “There is data from basic science studies that have shown that Covid-19 itself binds to a protein at the surface of cells called ACE2,” he said. “There is a hypothetical risk that giving NSAIDs like ibuprofen could increase levels of ACE2 shown in animal models, but not in patients.”
 - https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600...
 - https://kvia.com/health/2020/03/17/france-says-ibuprofen-may...
 - https://news.ycombinator.com/item?id=22611363
Why? They knew the data was fake when they published it, but they published it anyway to boost sales of Remdesivir.
They're literally trying to make money by killing people. If you wouldn't trust someone if you saw them run over someone else with their car, why would you trust Lancet?
Peer Review gone wrong -> https://www.youtube.com/watch?v=wLlA1w4OZWQ
Precisely the way trump himself behaves, but you don't point that out.
You illustrate my point by assuming that I'm supporting him, just because I'm not criticizing him.
So what you're saying is we should never fully trust these journals? We should always be skeptical?
That's what I'm saying too...
YES, you should be skeptical, but mostly not at the journal-level. You need to be skeptical at the article-level. That is why it's so important to be actually TRAINED to interpret the studies.
The abstract of a trial is like an "advertisement" for the study. You quickly scan it to see if the study is worth reading. If it is, you make multiple passes of the article, identifying biases, understanding the study context, calculating ratios and numbers, reading through the lens of your own practice, and a bunch of other things.
So yes, I'd argue that brand names are a big problem. You just have to see how proud people are when they are accepted in one of the major publication venues, and the prestige that results.
I think you are not being objective.
"No, the real scandal is that the respected medical journal Lancet aids and abets in poor research practices by serving as a kind of shield for the authors of a questionable paper, by acting as if secret pre-publication review has more validity than open post-publication review." 
HN isn’t the ideal venue for hyperbole.
One should always be skeptical of research and have dicsussions on the reported data and to what extent and in what context it makes sense. The media outlets summarizing the research papers very often fail to do that so as to skip the details and keep the readers happy because they assume "readers just want to know the superficial abstract knowledge, they can't possibly be interested in the critical analysis of the figures and the numbers so let's exclude that".
I think that exactly how good scientists proceed. This isn't my field, but my understanding is that research groups don't "fully trust" peer reviewed research, so they usually attempt to replicate the key results they plan to cite in their new research.
In fact, scientists often say, somewhat tongue-in-cheek, "It's published in Nature, so it's probably wrong" (the more revolutionary a result, the more likely it is to be wrong, but also the more likely it is to get into one of the top journals).
If your implication is that the media and the science community conspired to make the president look stupid, I think you've got a big hill to climb to prove that.
...and I think it's possible that's what we see here. An emotional decision to publish, and then no one wanted to contradict because no one wanted to be viewed as a Trump sympathizer.
This incident comes in the middle of the replication crisis, with 50%-70% of studies failing replication, including in the medical sciences field. Furthermore, many suspect that BigPharma pushes inconclusive garbage as peer reviewed science to promote commercial interests. Then there is the response to covid19, which, justified or not, some regard as catastrophic overreaction. The BigScience enterprise is in peril of losing public trust. Which is a terrible loss.
Lancet / NEJM editors failed. There are no excuses. The right course of action is to apologize, not to further antagonize the public. Try humility for a while.
Who can you trust these days?
First, there are some really good science reporters out there, doing excellent work. I recommend Ed Yong at the Atlantic, Helen Branswell of STAT News, Jon Cohen at Science, Amy Maxmen at Nature. There are others (it's a team effort and those are all great publications), but if you just read all of the articles under their bylines, you will get a good overview of what's going on. They will not let you down.
If you have a little bit more time and energy for this stuff (as I do), then there are many experts on Twitter who freely share their analysis, and among them are some excellent communicators. When controversial stuff comes out, you can get a good sense very quickly what the flaws are and what seems to be the consensus. If you want to dip your toes into these waters, I recommend Angela Rasmussen, Trevor Bedford, and Marc Lipsitch. For critical analysis of bullshit published by seemingly reputable academics, I highly recommend Carl Bergstrom (his takedowns are highly entertaining as well as informative).
It's frustrating for me to see such pearls of knowledge and expertise so freely available, yet the vast majority of people snarfing down huge quantities of information swill.
 human-to-human transmission doesn't happen; masks are ineffective; HCQ is horribly risky; a vaccine is coming;
And this: "Before the Covid outbreak, remdesivir was a drug for which Gilead had failed to find a use." (Barrons 6/2/2020)
It’s going to take a long time to recover from what the media has done here. HCQ isn’t even allowed as a treatment in a lot of places, or require hospitalization (funny for a drug on the market for 60 years and over the counter in some places).
Other countries are ramping up production and we’re still dealing with the yet another casualty of culture war.