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Here is a great example of why I keep pointing out how difficult it is to be a critical thinker. There isn't a single source to go to that gives the current status of HCQ + COVID, and there are dozens of links to journals in this thread that are making my head spin. So when people ask my opinion on HCQ, my answer is now: "I don't know, we don't have enough data that has been studied and approved by multiple peer-reviewed journals, because one isn't enough."

This doesn't shake my attitude toward science in the slightest, but it does leave me feeling very uninformed. But maybe, just maybe, that is the correct phase-state to be in given the data? Or have I been zone-flooded?




What you’re feeling is what real scientific research feels like in real time.

We spend so much time in science classes learning what past scientists have already proven correct, and people come to believe that that is how science is in general: correct.

But working researchers spend most of their time not knowing what is correct, and sometimes not even knowing how to measure correctness. They wallow in uncertainty; that’s what makes it research.


That's not only a correct attitude, it's an absolutely essential one for anybody who takes science seriously.

I mean, now you can understand why the WHO is always putting out statements along the lines of "no evidence yet for X", while random bloggers and HN commentators are already completely convinced of X (or completely convinced against it). Real knowledge takes time. Individual studies don't settle questions.


My answer is "we don't know but there seems to be little harm in trying it." This is what's happening right now. Sure, it's a bit of a shotgun approach, but again, if Drs want to used an already fda approved drug and try various approaches to see if it helps, I see no issue. Honestly, I don't get all the politics around this.


> ... there seems to be little harm in trying it [...] if Drs want to used an already fda approved drug ...

All drugs have side effects, for example https://www.webmd.com/drugs/2/drug-5482/hydroxychloroquine-o... So each drug is a (small) risk for the patient. The idea of testing the drugs in RCT before using in the patients in the wild is that you can be quite sure that the benefits are greater than the risks.


There's plenty of possible harm by applying unproven treatments to patients in serious condition. Even if said treatment was deemed to be safe in other instances. Also drug interactions have to be accounted for. It might also exacerbate conditions from this pathology (for instance, further stresses on the cardiovascular system are dangerous for COVID patients).

We are not shamans.


> there seems to be little harm in trying it

Do you have a link to that research?


> “There is a growing mountain of research. But there is increased evidence that we are being bogged down today as specialization extends. The investigator is staggered by the findings and conclusions of thousands of other workers—conclusions which he cannot find time to grasp, much less to remember, as they appear.”

> “The difficulty seems to be, not so much that we publish unduly in view of the extent and variety of present day interests, but rather that publication has been extended far beyond our present ability to make real use of the record. The summation of human experience is being expanded at a prodigious rate, and the means we use for threading through the consequent maze to the momentarily important item is the same as was used in the days of square-rigged ships.”

- Vannevar Bush, As We May Think (1945): https://www.theatlantic.com/magazine/archive/1945/07/as-we-m...


What a fascinating article. Thank you for sharing it. It truly shows how much we have progressed and has an optimism that is so refreshing considering it was written right before the end of one of humanity's most deadly/vicious war.

It really , really puts things in perspective and makes me wonder how we are doing much better relatively to most people in ww2 but yet we don't seem to have (or even wish for) a positive outlook on life and the future.


I think not having an opinion on the efficacy of a particular medical treatment is the correct phase-state for anyone who is not a medical professional.


The reality is that although we've improved, we're still slow getting data reliably, analyzing and understanding it. Science is actually a very manual labor.


Not to mention the difficulties with the i/o. next generation sequencing files, depending on the analysis done and the state in the pipeline, are just plain text files (sometimes binary for efficiency) but like 5-100s of GB in size per sample. If you maybe have a thousand samples, good for statistical power, you need terabytes of storage available, a lot of memory, and a lot of fast cores, so the natural answer is to use a compute cluster and some universities have them for their researchers. Not everyone has access to $100k of parallel computing power, however.


The entire CV-19 episode is going to prove to be a master class in critical thinking skills. I think there's a great book in there somewhere. This is a story of common wisdom and normal channels continuing to get it wrong. (and then the eventual correction occurs)

With HCQ, there are multiple layers of noise to disentangle. Best I've got, and I've been watching this for months, is that HCQ and antivirals, in general are somewhat useful before you get infected or extremely early in the infection. They don't cure anything and nobody expected them to. They're also not appropriate to give to people by the time they show up to the hospital. By then it's too late.

That's general advice that has nothing to do with CV-19. It might be relevant that some of these drugs have been around for over 100 years and while not mundane and harmless, they have well-known safety profiles. (Other drugs that might be included in this group would be Tamiflu, or Acyclovir)

So that's the general advice you might get a year ago if you went out with a doctor and had a couple of beers. As you know, however, the HCQ thing especially got severely political. Suddenly we were seeing studies where doctors gave large doses to ICU patients, and implemented a lot of other protocols that made no sense, probably ended up hurting people, but made for good headlines.

As an outsider, there seemed to be a sort of "competition" in some parts of the academic community to come up with various papers that could technically be called scientific, but existed much more as a publicity vehicle. I could easily count a couple of dozen studies, on various topics, that were not of a high quality. I imagine there are all sorts of reasons for that.

Now we're reaching the apex of this small deviation in the mainstream of scientific research. We've got tons of data of dubious provenance being distributed to various studies to say things we're already primed to hear. It was only because a lot of people took the time to call bullshit that this was caught. Congrats to the folks that did that work.

I have no opinion about any of these drugs, but that's my evaluation of the technical quality of the discussion in the area you bring up. I think the it will eventually will all work out, and it's going to make a hell of a story to tell. But we've got a ways to go yet for all of the systems involved to adapt as they need to. We've made great progress. In many ways, CV-19 was not the pandemic everybody was expecting, and it was quite difficult for many organizations to change gears as quickly as required.


HCQ is no miracle. When used without zinc and when used too late it may not help.

It's best used with zinc and early. That's what five studies confirmed here:

https://academic.oup.com/aje/advance-article/doi/10.1093/aje...


Since this is being repeated multiple times, quoting benmaraschino:

One of these "studies" is a 2-page Google Doc with no real data. Another is the discredited Raoult study, which is under investigation by the journal [1]. Another study cited is also by Raoult's team. The Brazil study (ref. 29) doesn't seem to have passed peer review (yet?) and has severe methodological flaws. Like the Raoult studies, the Brazil study was not randomized, but makes no attempt to control for confounding by indication or self-selection, such as with propensity score matching or similar methods commonly used in observational studies. The last study cited isn't a study, but an article from a local news station.


Can someone report this guy for spam/bot?




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