Still no control group, though. Isn't the author of this study the same individual whose history of faking data was discussed on Twitter earlier today?
Yep, it's him. I'll wait for a reproduction from an independent group before believing this.
If I may say: be especially wary of people who tell you that what you want to believe is true. It's not necessarily that they're more likely to lie. It's that your guard is more likely to be down against mistakes in their reasoning. Doubt is the province of the wise.
I don't understand why there wasn't a control - placebo effect would matter here and 1/80 dead could just simply be an effect of these patients being more closely monitored in the study, it doesn't sound too far off from the 1.2% death rate you see cited in some publications. This just isn't a confidence inducing paper.
It's also a really well written paper. Isn't it impressive how people just read into it and assume that there must be all these criteria that make the data better without them being detailed or a control group? Not many academic papers can communicate things (of differing levels of veracity) that they want to communicate but can't say explicitly so well.
There seem to be a huge number of people reading about this topic online who just want to be comforted and are willing to throw all critical thinking out the window to that end. That's the only way I can figure why all these optimistic but poorly designed papers are being cheered on places like HN and /r/covid19, not to mention the news.
Theres a reason even the language of scams - snake oil - has an origin in health panacea. Health and money have ways of getting people to believe things that they should be quite a bit more sceptical of.
People who work in his lab/hospital? Tbh the participation of a single data faker in a study throws the whole thing into question. Surely not all of these people can be ignorant of his history? So they are ignoring it instead. Why would this be? Perhaps because you are dependent on the faker in some way?
If there is a weak link in the causal chain it throws the whole thing into doubt. An author with history of faked data combined with exceptionally weak and low powered study design yields weak evidence. I barely count this as evidence in either direction about whether this therapy is effective.
> [On patient died but] For all other patients in this cohort of 80 people, the combination of hydroxychloroquine and azithromycin resulted in a clinical improvement that appeared significant when compared to the natural evolution in patients with a definite outcome.
Note patients were excluded based on an extensive list of contra-indications, and there was care taken to avoid one of the known side-effects, heart arrhythmia; EEGs were taken before and during treatment and reviewed by cardiologists.
Also note that this treatment is not preventive, but rather would be used to treat people with serious illness, to shorten the illness. Given that, and the lengthy list of contra-indications and potential for serious side-effects, it could be useful in reducing deaths among infected people, but not in reducing infections, nor -- given you need to be pretty sick to justify the risks -- in reducing hospitalizations.
Lest others also experience HN's hug-of-death of the original source, Google's cached version (https://webcache.googleusercontent.com/search?q=cache:bkjo_-...) works as interim alternative version of the original PDF before the link returns or e.g. Wayback Machine has a chance to archive it.
(This aside, heed @asdfasgasdgasdg's very prudent note of caution; other independent and more reputable replications are essential.
As of this writing there are at least 19 such hydroxychloroquine trials in US (https://clinicaltrials.gov/ct2/results?term=Hydroxychloroqui...) and more beyond (though WHO clinical trial site listing them is also apparently under critically-heavy load).)
The lack of a control group is frustrating, but the comparison to outcomes in untreated groups documented in China still makes me feel this treatment holds promise:
"For all other patients in this cohort of 80 people, the combination of hydroxychloroquine and azithromycin resulted in a clinical improvement that appeared significant when compared to the natural evolution in patients with a definite outcome, as described in the literature. In a cohort of 191 Chinese inpatients, of whom 95% received antibiotics and 21% received an association of lopinavir and ritonavir, the median duration of fever was 12 days and that of cough 19 days in survivors, with a 28% case-fatality rate (18). The favourable evolution of our patients under hydroxychloroquine and azithromycin was associated with a relatively rapid decrease in viral RNA load as assessed by PCR, which was even more rapid when assessed by culture."
I find it too easy for people not on the front line to criticise those who are.
1. Chloroquine has been used since 1949 for treating a range of diseases including malaria, and is therefore a well known drug which causes complication only in rare cases because its side effects and use are well known, it's even given in prevention to healthy people travelling in certain parts of the world
2. Pr Raoult has demonstrated 13 years ago its effectiveness against coronaviruses
3. The current CV19 pandemic is killing people at an alarming rate
4. In Europe hospitals are stretched beyond capacity meaning more are dying for lack of space/equipment/attention/treatment, and not because of CV19 itself
5. As a world renown specialist Pr Raoult has been in contact with doctors in China who were the first to use it to treat CV19 and observe its effectiveness in greatly reducing the viral load
6. As director of a research hospital Pr Raoul is on the front line for handling CV19 patients and is responsible for making life and death decisions not just for his own life but for all patients arriving in mass to his door
7. There is no other alternative treatment to date for CV19, some other drugs are promising but are either much newer and less known, or heavier on side effects and cost
Now take into account the above facts, imagine yourself in Pr Raoult shoes, and realise that withholding the use of chloroquine in such dire situation, where the luxury of a full study cannot be afforded and the drug is very well known, can be considered not only immoral but also criminal. In other words when the choice is either to let people die with a "wait and see" attitude, or to save lives by significantly reducing the viral load and infection with a well known drug, the choice is clear. Another way to view the situation: you are a policeman stopping an ambulance not respecting the driving code and driving too fast, and then learn there is a dying patient in the back, what do you do?
Also Pr Raoult does not claim he has done a full study. Those that get finicky and still want to have a full study before allowing its use are irresponsible people who have no idea of what's it's like on the ground. Those that criticise him as a lone advocate are really out of touch with reality: he is definitely not alone, he's got 200 staff under his responsibility, 80 of which are researchers, he has been on the forefront of his field worldwide (see his wikipedia page), knows very well how to perform perfect academic studies, and is and has been constantly talking with specialists and doctors around the world since the earliest time of the pandemic.
Chloroquine has side effects and the drug might not work. It'd make the front blinds a hell of a lot worse if we start giving people whatever without any scientific basis just because one charismatic scientist has been pushing for it. Ignoring the science is what got us here. Staying blind to science to pursue false hope isn't going to get us out of here. Remember how during Ebola we were all convinced that drug by Gilead was going to work since it seemed to have an impact on the mechanism of action etc etc? Remember how it failed after rigorous studies? Imagine if we'd just decided it worked without testing it on preliminary data and given it to people on the front lines to protect themselves.
These regulations are written in blood. Dengue vaccines are another example. Ignoring science got us here. Ignoring science again will keep us here.
Today France authorized the use of hydroxychloroquine for the treatment of covid-19 - based on this study. So the study has had impact on policy already.
see point #2, plus all the hindsight of using this drug since 1949
> during Ebola we were all convinced that drug by Gilead was going to work
You mean Remdesivir, a drug which is barely 5 years old in the clinical world? For that one yes, precautionary principle should have a much higher precedence over the urgency, but for a well known drug like chloroquine which is normally available OTC, sorry saving lives comes first.
I take it you are not on the front line and have no immediate responsibility of the life and death of those infected.
https://forbetterscience.com/2020/03/26/chloroquine-genius-d...
Yep, it's him. I'll wait for a reproduction from an independent group before believing this.
If I may say: be especially wary of people who tell you that what you want to believe is true. It's not necessarily that they're more likely to lie. It's that your guard is more likely to be down against mistakes in their reasoning. Doubt is the province of the wise.