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Yale epidemiologist Harvey Risch defends hydroxychloroquine in Newsweek—badly

Yale epidemiology professor Harvey Risch published an embarrassingly bad op-ed in Newsweek defending hydroxychloroquine to treat COVID-19. It reminded me how much acupuncture and hydroxychloroquine believers have in common.

I’m generally a big fan of epidemiology and epidemiologists. After all, epidemiology is how we know that tobacco smoking causes cancer and that vaccines do not cause autism, sudden infant death syndrome, autoimmune diseases, diabetes, or the other conditions and diseases attributed to vaccines by antivaxxers. Epidemiology is also how we will ultimately figure out who is at most risk for serious disease, complications, and death from COVID-19 and then use that information to fine tune the public health response to the pandemic and to develop additional interventions. So I scratched my head mightily yesterday when I saw an op-ed in Newsweek by Harvey Risch, MD, PhD, a professor of epidemiology at the Yale School of Public Health entitled The Key to Defeating COVID-19 Already Exists. We Need to Start Using It. What is this “key” that Risch is talking about? Hydroxychloroquine. No, seriously, I kid you not. He’s talking about what I’ve started calling the “acupuncture of the COVID-19 pandemic”:

As professor of epidemiology at Yale School of Public Health, I have authored over 300 peer-reviewed publications and currently hold senior positions on the editorial boards of several leading journals. I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines. As a result, tens of thousands of patients with COVID-19 are dying unnecessarily. Fortunately, the situation can be reversed easily and quickly.

I am referring, of course, to the medication hydroxychloroquine. When this inexpensive oral medication is given very early in the course of illness, before the virus has had time to multiply beyond control, it has shown to be highly effective, especially when given in combination with the antibiotics azithromycin or doxycycline and the nutritional supplement zinc.

This far into the pandemic, with double-blind, randomized, controlled clinical trials starting to be published and showing, each and every one of them so far, that hydroxychloroquine shows no benefit versus COVID-19 (I’ll discuss them shortly), let’s just say that I am flummoxed to find, in the midst of a crisis, that a seemingly respected epidemiologist is fighting for a drug that almost certainly doesn’t work based on low quality and anecdotal evidence when far higher quality evidence is becoming available and even the bulk of the observational evidence has been negative, with one notable outlier. I am even more flummoxed to find that Newsweek provided this epidemiologist a platform to promote this argument, particularly given how he based it primarily on a commentary and review that he wrote in May, which is basically ancient history as far as the evidence base for hydroxychloroquine goes.

Next up, Risch uses an appeal to authority—his, and that of an epidemiology journal:

On May 27, I published an article in the American Journal of Epidemiology (AJE) entitled, “Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.” That article, published in the world’s leading epidemiology journal, analyzed five studies, demonstrating clear-cut and significant benefits to treated patients, plus other very large studies that showed the medication safety.

This sort of appeal to the respectability of a scientific journal just makes me laugh these days. Journals far more prestigious than AJE have published utter rubbish before, for example The Lancet‘s publication of Andrew Wakefield‘s case series and that awful Surgisphere study on hydroxychloroquine in May. I could go on and name many other bad or even fraudulent papers in many other journals, but instead I’ll just refer to Retraction Watch for a sampling. The point is simple. Being published in a respected journal is not a guarantee of quality or that the study is even right. Indeed, I often point out that the highest profile journals, the ones that publish the most bleeding edge research, probably have a higher rate of studies that turn out to be wrong, because that’s what happens on the bleeding edge of science. Surely the eminent Prof. Risch knows this, but he makes the appeal anyway.

Since Prof. Risch referenced his own opinion article in AJE, I figured that I had to go and take a look at it. At this point, Newsweek annoyed the crap out of me because there was no direct link to the article, forcing me to go to the extra step of Googling its title and finding the article. Come on, Newsweek! It’s 2020! There’s no excuse for not including a direct link to the source and hasn’t been for at least a decade! Here, by the way, is the direct link. At this point, I would also like to point out that Prof. Risch is on the editorial board of AJE, a fact conveniently not mentioned in his Newsweek op-ed that is highly relevant, given that editorial board members can exercise a lot of influence on what gets published in a journal.

Reading the article, I was struck at how weak the arguments were. Prof. Risch basically tries to compare hydroxychloroquine to remdesivir, which I discussed nearly three months ago, when the results of the first randomized clinical trial (RCT) was announced, in essence, by press release. And, guess what? I’m not that impressed with the evidence for remdesivir’s efficacy against COVID-19, either! Prof. Risch argues:

More specific for consideration here, remdesivir has not been studied in outpatient use. The Scientists to Stop Covid-19 “secret” Report (12, p. 7) recommends widespread use of remdesivir, and “as early in infection as possible,” but no actual evidence as yet shows in humans that it would be helpful for routine outpatient circumstances and disease. The FDA recently approved use of remdesivir in the current public-health emergency circumstances (13), but only for patients with “severe disease defined as SpO2≤94% on room air, requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO)” and “administered in an in-patient hospital setting via intravenous (IV) infusion by a healthcare provider.” This approval seems specifically not to allow outpatient use. Symptomatic outpatient infection is a pathologically and clinically different disease than the life-threatening inpatient acute respiratory distress syndrome caused by SARS-CoV-2, thus there is little reason to think that the same treatment would be useful for both (14).

Funny, though, until recently, hydroxychloroquine cultists were claiming that the drug would be effective against COVID-19 in seriously ill hospitalized patients and then, as evidence accumulated that it isn’t, pivoted to the argument that it has to be given as early as possible in order to work. Clearly, there is a double standard at work here that Prof. Risch is not acknowledging. (We wouldn’t want to suggest that goalposts are being moved, would we?) Moreover, his argument is bullshit, plain and simple. If a drug strongly inhibits coronavirus replication, there’s no reason that it couldn’t be effective both in advanced disease and in early disease—or even as a prophylactic treatment to prevent infection. It’s true that it might not work as well (or at all) in all those situations, and it’s even true that one treatment is unlikely to work as well (or at all) in all those clinical situations, but there’s no a priori scientific reason to make the blanket declaration that one treatment can’t possibly be useful in both situations.

Think of it this way. The life-threatening inpatient acute respiratory distress syndrome caused by SARS-CoV-2 is on a continuum of disease, not a completely different disease, from symptomatic outpatient infection. In any event, I also agree that, because remdesivir hasn’t been studied in outpatient use, its use in outpatients is currently not that well supported, but, then, it is an intravenous medication only at present, making this argument rather a straw man, a red herring.

The rest of Prof. Risch’s AJE article is a veritable Gish gallop of cherry-picked studies. Hilariously, he relies heavily on uncontrolled “studies” and case series from two grifters, Didier Raoult and Vladimir Zelenko. I’ve written about Didier Raoult, a “brave maverick” true believer in his combination of hydroxychloroquine and azithromycin and a bully, on several occasions, starting with his truly execrable study claiming that his combination of hydroxychloroquine and azithromycin cleared coronavirus in all patients. None of these studies were controlled or randomized. Unbelievably, Prof. Risch cites Raoult’s case series of 1,061 COVID-19 patients as though it were anything but singularly uninformative and useless for evaluating whether his drug combination is effective against COVID-19.

That’s not the most embarrassing thing in Prof. Risch’s article, though. This is:

The first study of HCQ+AZ (24) was controlled but not randomized or blinded, and involved 42 patients in Marseilles, France. This study showed a 50-fold benefit of HCQ+AZ vs standard-of-care, with P-value=.0007. In the study, six patients progressed, stopped medication use and left the trial before the day-6 planned outcome measure of swabsampled nasopharyngeal viral clearance. Reanalysis of the raw study data elsewhere (25) and by myself shows that including these six patients does not much change the 50-fold benefit. What does change the magnitude of benefit is presentation with asymptomatic or upper respiratorytract infection, vs lower respiratory-tract infection, the latter cutting the efficacy in half, 25-fold vs standard-of-care. This shows that the sooner these medications are used, the better their effectiveness, as would be expected for viral early respiratory disease. The average start date of medication use in this study was day-4 of symptoms. This study has been criticized on various grounds that are not germane to the science, but the most salient criticism is the lack of randomization into the control and treatment groups. This is a valid general scientific criticism, but does not represent epidemiologic experience in this instance. If the study had shown a 2-fold or perhaps 3-fold benefit, that magnitude of result could be postulated to have occurred because of subject-group differences from lack of randomization. However, the 25-fold or 50-fold benefit found in this study is not amenable to lack of randomization as the sole reason for such a huge magnitude of benefit. Further, the study showed a significant, 7-fold benefit of taking HCQ+AZ over HCQ alone, P-value=.035, which cannot be explained by differential characteristics of the controls, since it compares one treatment group to the other, and the treated subjects who received AZ had more progressed pneumonia than the treated subjects receiving HCQ alone, which should otherwise have led to worse outcomes. The study has also been described as “small,” but that criticism only applies to studies not finding statistical significance. Once a result has exceeded plausible chance finding, greater statistical significance does not contribute to evidence for causation (26).

I had a hard time believing that an actual professor of epidemiology at a school as reputable as Yale could write such drivel. The study he is referring to is Gautret et al., a study so awful, so full of flaws (and maybe even fraudulent), that it was quite properly dragged on science and medical Twitter for days and weeks afterward. That Prof. Risch would cite such an abomination of science tells you all you need to know about him.

Next, Prof. Risch cites Vladimir Zelenko. No, seriously, an epidemiologist is citing an unethical case series that hadn’t even been published yet in May. The link he provides in the citation is a link to a Google Documents page that no longer exists and was last accessed in April. I suspect that this was probably the same spreadsheet of patients that Zelenko had posted in early April that looked like this. I’m now leaning towards Prof. Risch’s commentary having not been peer-reviewed, because if an AJE peer reviewer let an author cite a link to a Google Document and call it a “two-page report,” its peer review sucks, and its editor should be ashamed of himself for publishing this. Zelenko’s evidence is so crappy that anyone citing it seriously should be thoroughly mocked.

The fourth study cited by Prof. Risch is the Prevent Senior study carried out in Brazil. It, too, was an awful study, as outlined by Elisabeth Bik. There was no randomization and no good documentation if the patients actually had COVID-19 or not. The two groups compared were not equally sick, and the reasons for hospitalizations and deaths were not listed. Moreover, the study was performed by an insurance company in Brazil which was promoting its telemedicine app for COVID-19:

Seriously, this is embarrassing. Prof. Risch’s article should really be retracted. It’s that bad. The comments published about it were deservedly scathing, and Prof. Risch’s responses to the criticisms were downright embarrassing, basically doubling down and dismissing valid criticisms, while pulling the “delay can’t be tolerated during a pandemic” gambit.

But back to the Newsweek op-ed:

Since publication of my May 27 article, seven more studies have demonstrated similar benefit. In a lengthy follow-up letter, also published by AJE, I discuss these seven studies and renew my call for the immediate early use of hydroxychloroquine in high-risk patients. These seven studies include: an additional 400 high-risk patients treated by Dr. Vladimir Zelenko, with zero deaths; four studies totaling almost 500 high-risk patients treated in nursing homes and clinics across the U.S., with no deaths; a controlled trial of more than 700 high-risk patients in Brazil, with significantly reduced risk of hospitalization and two deaths among 334 patients treated with hydroxychloroquine; and another study of 398 matched patients in France, also with significantly reduced hospitalization risk. Since my letter was published, even more doctors have reported to me their completely successful use.

This is painful to read. Seriously, this is an epidemiologist? Apparently so, but he’s an epidemiologist who confuses correlation with causation:

Beyond these studies of individual patients, we have seen what happens in large populations when these drugs are used. These have been “natural experiments.” In the northern Brazil state of Pará, COVID-19 deaths were increasing exponentially. On April 6, the public hospital network purchased 75,000 doses of azithromycin and 90,000 doses of hydroxychloroquine. Over the next few weeks, authorities began distributing these medications to infected individuals. Even though new cases continued to occur, on May 22 the death rate started to plummet and is now about one-eighth what it was at the peak.

A reverse natural experiment happened in Switzerland. On May 27, the Swiss national government banned outpatient use of hydroxychloroquine for COVID-19. Around June 10, COVID-19 deaths increased four-fold and remained elevated. On June 11, the Swiss government revoked the ban, and on June 23 the death rate reverted to what it had been beforehand. People who die from COVID-19 live about three to five weeks from the start of symptoms, which makes the evidence of a causal relation in these experiments strong. Both episodes suggest that a combination of hydroxychloroquine and its companion medications reduces mortality and should be immediately adopted as the new standard of care in high-risk patients.

An Epidemiology 101 student should be able to dismantle the argument above. This is the sort of argument antivaxxers make, such as that the expansion of the vaccine schedule in the early 1990s was followed by a rise in the prevalence of autism, or claims that nations with more vaccines in their recommended schedule have higher infant mortality rates. The question to ask is: What else happened around the times that the magic drug hydroxychloroquine was disbursed to Pará or taken away from Switzerland? But, no. Whatever changes in COVID-19 mortality we’re observed must be due to the magic drug. Also, which is it? I thought that the addition of azithromycin, zinc, or doxycycline to the hydroxychloroquine was important!

It amuses me that on the very same day that Prof. Risch published his Newsweek op-ed, the New England Journal of Medicine published a clinical trial of 667 patients with mild-to-moderate COVID-19 randomized to receive placebo or hydroxychloroquine (with and without azithromycin, yet!), with the primary outcome being clinical status at 15 days. Can you guess what the result was? (Sure, I knew you could.) It was completely negative. But, wait! I can see Prof. Risch countering with the observation that this was a trial of hospitalized patients. We have that covered too! One week ago yet another randomized controlled trial of hydroxychloroquine was published in Clinical Infectious Diseases. It was a Spanish trial of 293 non-hospitalized patients with mild COVID-19, exactly the sort of study that Prof. Risch wanted. Guess what? It was negative. No benefit was observed with HCQ beyond the usual care. It is true that both of these studies did have one significant weakness, namely that they were both open label, but an open-label randomized trials are still way better in terms of determining the efficacy of a drug than any of the crappy observational studies cited by Prof. Risch to argue that everyone should be getting hydroxychloroquine now. One could even argue that the trials were underpowered to detect smaller effects, but Prof. Risch is not claiming small effects on mortality. Here’s claiming that hydroxychloroquine is a game changer that could save hundreds of thousands of lives!

This study was only the latest in the drip-drip-drip of negative studies of hydroxychloroquine. Before that, there was the publication of a a randomized controlled clinical trial of the drug as post-exposure prophylaxis that was entirely negative. This was followed by two more, first, a Spanish post-exposure prophylaxis trial that was also negative. Then there was the Recovery Trial from the UK, which failed to find a benefit from hydroxychloroquine in hospitalized patients treated with the drug, leading to the revocation of the EUA.

Prof. Risch notes:

First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed. We must judge this medication strictly on the science. When doctors graduate from medical school, they formally promise to make the health and life of the patient their first consideration, without biases of race, religion, nationality, social standing—or political affiliation. Lives must come first.

I agree that the issue has become politicized, but who caused the politicization? It was clearly the hydroxychloroquine cultists associated with Donald Trump and, indeed, Donald Trump himself. I also agree that we must judge this medication strictly on the science, which is why I conclude that there was no scientific or ethical reason for hydroxychloroquine to become a de facto standard of care for COVID-19 before proper randomized controlled trials were completed showing benefit.

Prof. Risch concludes by destroying yet another one of my irony meters:

In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence. But for now, reality demands a clear, scientific eye on the evidence and where it points. For the sake of high-risk patients, for the sake of our parents and grandparents, for the sake of the unemployed, for our economy and for our polity, especially those disproportionally affected, we must start treating immediately.

The first two sentences could have been written by me. No, really, they could. I’ve been saying how politics and ideology have overridden the science when it comes to hydroxychloroquine. The difference is that I come to exactly the opposite conclusion, namely that it was the hydroxychloroquine cultists who were driving the use of this medication in the absence of any good evidence (or even a powerful scientific rationale) for its efficacy. (Indeed, one recent in vitro paper showed that chloroquine (a drug highly related to hydroxychloroquine) can’t inhibit infection of human lung cells with SARS-CoV-2, and a recent primate study shows that hydroxychloroquine doesn’t protect against infection with SARS-CoV-2.)

I’d be willing to bet that Prof. Risch has no idea how the idea that the antimalarial drugs chloroquine or hydroxychloroquine might have efficacy against COVID-19 came to be; so I’ll repeat the story to show just how flimsy the evidence base was. Based on an observation of 80 patients full of confirmation bias, Chinese doctors in Wuhan noted that no patients with lupus erythematosis became ill with COVID-19 and hypothesized that the chloroquine or hydroxychloroquine that they were taking might be the reason. (These drugs are also mildly immunosuppressive, hence their use to treat autoimmune diseases.) Of course, during a pandemic, it is people who are immunosuppressed are the very people who most rigorously obey orders to practice social distancing and self-quarantine and thereby protect themselves from infection. Be that as it may, the Chinese doctors started using the antimalarial drugs, and anecdotal evidence of success was reported, leading to randomized clinical trials that were announced by the Chinese government to have been “promising.” None of this stopped China from incorporating these drugs into its recommended regimen. The World Health Organization followed suit, as did several countries, and thus was born a new de facto standard of care for COVID-19 based on, in essence, no evidence other than some in vitro evidence that the drugs inhibit replication of SARS-CoV-2, the virus that causes COVID-19, anecdotes, and incredibly weak clinical trial evidence. Now the randomized clinical trial evidence is starting to accumulate, and it’s basically in line with the very low prior probability that these antimalarial drugs could be effective against COVID-19

Hydroxychloroquine to is the acupuncture of the COVID-19 pandemic. What do I mean by that? Like acupuncture, hydroxychloroquine is an intervention with a very low prior plausibility (although, in fairness, the prior plausibility of acupuncture is much lower than even that of hydroxychloroquine) whose cultists behave just like acupuncture cultists when it comes to evidence. They believe their magic treatment works; so, like acupuncturists, they tend to downplay accumulating evidence from double-blind, placebo-controlled trials and point to much poorer quality observational studies, while making excuses like these, described for a similar situation, the use of vitamin C to treat cancer:

Because I’m dedicated to evidence and science when it comes to medical decision making, I always concede that it is still possible that hydroxychloroquine might still be found to have some anti-COVID-19 activity, although it’s becoming increasingly clear that, if there is any activity it will likely be very modest and require large clinical trials to detect, to the point where it’ll probably be clinically insignificant. That being said, it’s amazing how much believers in acupuncture, vitamin C to treat cancer, and hydroxychloroquine to treat COVID-19 have in common.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

216 replies on “Yale epidemiologist Harvey Risch defends hydroxychloroquine in Newsweek—badly”

“I am even more flummoxed to find that Newsweek provided this epidemiologist a platform to promote this argument…”

Not nearly as flummoxed as I am to find out that Newsweek still exists.

And, just yesterday, NEJM published another negative double-blind randomized controlled study of hydroxychloroquine, this time in 667 patients.

Also, re: Hofnagle’s comment about needing a higher dose – the true quacks will say it needs to be diluted more.

Claiming it works only under certain conditions is a great example of the Moving the Goalposts logical fallacy.

Not really. It is the case for nearly all antivirals that they must be taken early — from acyclovir to tamiflu to HIV meds.

Exactly! Making assumption that it doesn’t work late equals not working early is completely brainless. Operating on a cancer that is stage 0 has completely different suvival rate compared to stage 4- as you are a surgeon Dr. Orac you should know better. You can’t say that when all the patients you operated on stage 4 died soon after you should not operate at all on this cancer type (as we know we don’t operate on stage 4 usually except for palliatie purpose). And as some of your stage 0 cancer patient may still progress and die, you cannot also say the operation is dangerous and should not be done. If you want to wait for RCT for HCQ by all mean, but some earlier studies from some epidemiology papers and papers that you do not approve showed benefit, let the other doctors who believe in it try on th patient with informed consent, it is done regularly for off label use medication, why tie their hands? Unless it showed universal harm, which it didn’t, I think we should let the treating clinician decide, not surgeons nor politicians.

Of course, we already have evidence from randomized controlled clinical trials that hydroxychloroquine doesn’t work for:

  1. Early COVID-19
  2. Prevention of COVID-19 after a documented exposure to someone with coronavirus

RCTs trump retrospective observational evidence, and, in fact, most of the retrospective observational evidence published since April has ALSO concluded that hydroxychloroquine doesn’t work in any clinical situation for COVID-19, be it severe or mild disease, hospitalized patients or outpatients. Bottom line: The evidence shows pretty convincingly that HCQ doesn’t work against COVID-19.

It only works with ZINC. HCQ is a zinc ionophore and the mechanism is very well understood. Also what is really at work is Zinc and Zinc ionophores as it stops the replication of all Coronaviruses. You see it only works in certain conditions, and many old papers explain and test this. Coronavirus research is not new. So yes, understanding your problem makes it important to know under which conditions it helps: early before the viral overload takes place, and only in conjunction with a replicase blocker such as Zinc ion.

the mechanism is very well understood

In your own words, Daniel, explain in your own words.

Exactly. This is a sarcastic, illogical and disrespectful article and attack on a far more respected person, Harvey Risch as well as non sensical in many places. It is a reflection on the limitations of the author who makes several comments which are simply wrong:
1. Assuming if HCQ doesn’t work at late in disease it won’t work as early treatment…. like saying I just read the link to the article you sent from your friends. It is actually a terrible arrogant sarcastic attack on Harvey Risch and non sensical in many places. If that is the best your colleagues can do then I am reassured.
Apart from the tone of the writer… he makes several comments which are simply wrong:
1. Assuming if it doesn’t work late, so it won’t work as early treatment….that is. like saying treating early versus late cancer treatment shouldn’t make a difference. Or a heart attack. Or for asthma, or for any acute disease actually. Then criticising the researchers for ‘moving the goal posts’ to focusing on early treatment and prophylaxis which is the entire point!
2. No mention of Zinc as a necessary adjunct to treatment which also changes study outcomes- an essential part to improve effectiveness of a zinc ionophore… they need zinc to work well
3. Criticising doctors for not doing experimentation with RCT in a time of pandemic where people are sick and dying. Please don’t give me the dr who wants to give me the sugar pill if I am sick and they have something that works. Just like the vaccine studies have thrown the playbook out the window, everyone is now fast tracking.
Really, no respect for that writer and it is just a confirmation biased article with an arrogant, sarcastic, smug tone instead of a serious thoughtful response to consider the consequences of what they are actually doing in trying to crush concerned doctors who are working with real patients in a early treatment scenario.
The arrogance of this author is so concerning. It blinds him to how aggressive, illogical and foolish his words are.
I hope he can reflect back on this is the months ahead and hopefully learn the art of humility

…it is just a confirmation biased article with an arrogant, sarcastic, smug tone…

The arrogance of this author is so concerning. It blinds him to how aggressive, illogical and foolish his words are*.

I hope he can reflect back on this is the months ahead and hopefully learn the art of humility

I see that you also are a ‘nym of culture. I appreciate those who do their own research. I am also the product of the nonsensical ravings of a lunatic mind and we’re not alone — there are others hidden amongst the herd; We must find each other and shield each other against the fiery darts of the unwashed non-believers yeeted out from their ivory academic thones on high and their deep state operatives down low.

Q! Hear our cries, oh Q! Cast us off our masks, our muzzles, bring us together in intimate pill-popping snot-swapping embrace at the church and in the school, at the mall and in the pool 100 million strong. Come quick, Q.

Humility! What a bright idea! (<– I plagarized that)

*the man does know his M’ Python, though — It was very… powerful?

It only works with ZINC. HCQ is a zinc ionophore and the mechanism is very well understood.

I am always amazed at how on the internet something becomes a scientific fact based on a single, not very good paper.

No. The mechanism whereby HCQ becomes a zinc ionophore is not very well understood.

The HCQ cheering section really needs to catch up with the homeopaths and go straight for the quantum.

After saying the rationale behind the zinc+HCQ is nonsense, After being shown some papers supporting the treatment, Orac now says, well, “none of which has been demonstrated in humans…”

What exactly is the problem? Does zinc act differently in human cells, ie that it doesn’t inhibit CV replication? Zinc also inhibits HIV replication & that’s why HCQ has been used with AIDS.

Or do you think that HCQ doesn’t act as a zinc ionophore with human cells?

Here’s something more recent:

Medicine is full of not working good ideas. This is why one needs clinical trials. Besides of that, unspecific inhibition of enzymes is rather bad thing.

Zeb and Daniel, are you green monkey cells in a petri dish? Your more recent paper does extensive quoting of a fifteen year old study of chloroquine (not HCQ) working on SARS-CoV (not SARS-CoV-2) working for green monkey cells in a glass dish.

You HCQ fanboys need to let it go, there are better treatments. It is like you actually are green monkey cells in a petri dish!

@Zeb Perhaps you understand the problem better if I say that a cell culture cannot have a heart attack and cannot have respitatory distress either.

@Chris (September 6, 2020 at 12:44 pm)

You’re as funny as genital warts and your comments are as useless. You need to be more constructive in your comments or STFU.

To aid you & your misplaced cynicism, read this:

The politicization of HCQ has probably killed many thousands. Had Trump not gabbled about HCQ there would not have been the insane backlash, which included poorly designed trials & reviews. For example when you overdose patients with HCQ—as in the case of the UK Recovery trial—you can’t expect useful results. When you favor treatments for certain groups, you slant results. When you use the treatment without consideration of what the drug is supposedly doing, your results will probably have no value. (If HCQ’s role is to faciitate the inhibition of viral replication, it probably should be used as early as possible. Stop the virus, so stop the damage.)

If you’d like to read some reports on the efficacy of HCQ:

The six patients he referred to that dropped includes the person who died and the people who transferred to urgent care, right? I’m not an epidemiologist, but I would like an explanation on how not leaving out data about four people with bad outcome would not affect the results of a data set that only had 26 subjects in the treatment group altogether and leave intact a 25-50 rate benefit. Does that make sense?

In addition to the “you did it wrong!” excuse (common to explaining why various sorts of woo don’t work), what stood out in Prof. Risch’s remarks was this comment defending the Marseilles study:

“The study has also been described as “small,” but that criticism only applies to studies not finding statistical significance.”

Um, huh? So I can declare statistical significance in a study involving an even smaller population (maybe just two patients?) if there’s a test that’ll get me a p-value of .05?

You young whipper-snappers and p-values. In long past generations, it had a diffent connotation. That is, If you ran as fast as you can up to the edge of the road (without crossing onto it, like bowling) and released just at the right time there were some lads that could clear a two lane gravel road.


blockquote>The Oberth effect occurs because the propellant has more usable energy due to its kinetic energy in addition to its chemical potential energy. The vehicle is able to employ this kinetic energy to generate more mechanical power.

@ Dangerous Bacon

“Um, huh? So I can declare statistical significance in a study involving an even smaller population (maybe just two patients?) if there’s a test that’ll get me a p-value of .05?”

Well, from a purely technical and mathematical point of view, it is possible to perform stats on very small samples. And at times, that argument may be valid in very rigorously designed environments. But these very seldom occur in such medical matters, all the more when the stakes of getting things right are that high as with coronavirus. So he’s overstretching the argument pretty pretty far, as far as I can see.

Joel would have agreed with me on this last sentence… Sigh…

Joel would have agreed with me on this last sentence…

And he’d probably call me an ASSHOLE for being fascinated by the evolution of Risch’s hairdo. I have no idea what to make of this search result for Risch. The video has definitely been memory-holed, but the wrapper seems to still survive here.

@ Dangerous Bacon
Um, huh? So I can declare statistical significance in a study involving an even smaller population (maybe just two patients?) if there’s a test that’ll get me a p-value of .05?
A surprising number of not-terribly-statistically-sophisticated will argue that the results must be strong if they get p < 0.05 with a small sample. Face plant.

The New England article you laud is typical of the flimsy work used against HCQ. In their discussion section, the authors state: “ For the comparison between hydroxychloroquine and control, for example, our data are compatible with odds ratios as low as 0.69 and as high as 2.11.”.
So HCQ is either very good or very bad; great study…Dr. Risch is on the money — too bad there’s no money in HCQ to be made, and on the wrong side of the media war.

In other words, the confidence interval includes one, meaning that there was no detects statistically significant difference between the groups. Seriously, learn what confidence intervals mean.???‍♂️

Seriously, review Biostatistics 101, even the authors are citing the weakness of such a broad range in odds ratios; the study was lame.

As an outsider looking in for guidance on how to interpret Mr Risch’s commentary – I appreciate your citations of contrary evidence.

Your ego and condescension really get in the way.

Your critique was nauseating to read. Which is unfortunate, because you raised some very valid points.

You are your worst enemy.

“Another concern troll.” No, really–you could be your own worst enemy, assuming you wanted to enlighten your readers, but you seem more interested in receiving the applause of people who agree with you and relieving the pressure on your spleen, which is, after all, the main function of the Web. Jim Jones isn’t a concern troll, only concerned, having misunderstood your objective. Me, I’m not concerned, just a troll like you.

I can see it now. Concern trolls gather together for an evening and take turns reading out loud excerpts from RI. They attempt to outdo one another with much emoting. The others respond with sighing, hyperventilating, commiseration and intense emotional bonding. Before long the tension builds to the breaking point and they tear off their garments and in the heat of their passions make more concern trolls. The reported nausea is merely morning sickness. Orac has a lot to answer for.

So HCQ is either very good or very bad

Good grief! Where do these people come from?

We come from the place that busted the big Lancet anti-HCQ study that they had to retract…

I know the people who busted the bad Lancet study. The name “Jose Rios” does not feature there.

We come from the place that busted the big Lancet anti-HCQ study that they had to retract

That would not have included you though. Your understanding of statistical methods is appalling.

I’m laughing a little and embarrassed at the toxicity of this line of comments; I apologize for my mean-spirited tone! Truly it’s so frustrating that many lives are being cut short by a lack of scientific rigor, partisanship and greed as I perceive it — let’s stay skeptical, but hopefully constructive ✌?

Poor Dr. Harvey Risch. Being flummoxed is the first step in cognitive dissonance.

It’s probably inevitable. Keep thinking about it. Keep speaking up & start asking yourself … why … don’t stop searching. Eventually you will start to wonder if the only acceptable position is to say that nothing works, or will ever work; until a vaccine & you will have answered your own question. Which will only lead to more questions; a painful process.

@ DB,

Well, he’s an epidemiologist, so afaic; keep alienating him & watch that happen. Although, believe it or not, there is a long way to go between pro-HCQ & antivax; the Siren’s song of cognitive dissonance leads one to do exactly that. You can’t just stop after it’s started.

I’m sorry he’s being provoked but I expected several would be.

@ Christine Kincaid

“You can’t just stop after it’s started.”

You can. But it can drive you extremely angry and misanthropic. That’s what happened to me. But the gaslighting and cognitive dissonance was so obvious and extreme that it wasn’t that hard to identify it. Much harder to shrug off its consequences, however. Hence anger and misanthropy.

But the guy is an epidemiologist. He’s a grown up. He should know or have known for a long time that you cannot expect to spout shit without a significant evidentiary basis and not expect a backlash. With a bit of luck, he’ll think twice about it and come to his senses.

The first I heard (months ago) of HCQ+Zpac+zinc (all three drugs needed) was that the combination might be effective if given very early, before test results were available; poor if started when the patient was in ICU; and harmful if starting when the patient was on ventilation. There seem to be a great many studies (of many kinds by many people) confirming all of that initial report (especially the “poor” and “harmful” results). Why is there such lack of testing of protocols that match that initial report’s success — all three drugs very early? Is there a risk of patients recovering too soon, before they need ICU care?

“Before test results are available” is meaningless. You can get tested on day -3 or day 10. If I wave a magic wand over my trash can and then open it up to discover there’s no racoon in there, does that mean my magic wands prevents racoons from getting into the trash? That’s the kind of logic you’re pushing.

No magic; begin treatment when COVID-19 is suspected, before test results are available. No magic wand required. Actually, you’re using the test as a magic wand to determine whether or not to treat. That was not the reported protocol, which is to treat on suspicion. You will treat those who test negative, falsely or not, true, and those who eventually test positive, although you will treat all them when the protocol will be most effective. Your reason to delay treatment while you wait for the magic wand?

Except that this “treatment” has the potential to cause serious side effects. Treating people who may not have the virus is medically unethical.

Why is there such lack of testing of protocols that match that initial report’s success

Which initial report would that be, Otter? It’s not Raoult.

So you’re saying that the treatment worked well in people who may or may not have had the disease?
If you start the treatment, and then half the patients turn out to not have the disease, you darn well better not count them in the “works well” category, because that would be, frankly, lying.

Plus, claiming that it doesn’t work at certain stages of the disease? “Before test results” is NOT a disease stage.

Why don’t you go down to any ICU treating COVID patients and say that to the doctors and nurses directly….

How so? If HCQ worked for COVID then all the companies that make it would have a field day! Finally, a non-niche use for an anti-malarial that isn’t effective against malaria in big parts of the world.

Drug companies would be delighted to have an effective treatment they can sell without having to pay all those pesky development costs.

Any data found “before test results” is total nonsense. If results are negative then there’s no way to know if he patient had the virus to begin with which makes it pointless.

I’m still trying to figure out why a left biased source like Newsweek would publish this

It is mainstream. So are all mainstream periodicals in your world considered to be left biased? So what bias does the National Review have?

VJ appears to be another bot, so I wouldn’t expect it to engage in conversation. Mention of HCQ does seem to trigger their algorithms.

Why the assumption that hydroxychloroquine is the only drug already in use that could be an effective treatment for COVID-19?

Your answer, this paper, is a very good detailed reply with which I am full of support. However, I condemn the condescending tone you are using for your purpose. You are right all along. But using this tone – call it tongue in cheek if you want – is counterproductive and will only serve as a push back for people genuinely uncertain of what to think on this issue. Do not write only for people already on your side, but mostly as an educational tool for the misinformed

Oh, goody. Tone trolling. Just what Orac loves.???‍♂️

Let’s just put it this way: Sarcasm and snark have been Orac’s brand for over 15 years. It ain’t gonna change now just because a newbie doesn’t like it and is oh-so-“concerned” that the sarcasm detracts from the message.

I strongly suspect Patrick D is a bot (based on structure and content).

Trolls everywhere are in an uproar that their important contribution to public discourse is being displaced by a half dozen lines of Python code. Soon they’ll come out from under their bridges and march to Moscow to protest.

Good. Now I’m a bot. Actually, I’m a concerned respirologist and head of my University Hospital division – breathing and living in Canada. Maybe my sentence structure isn’t perfect as English is not my first language.
Good for you if sarcasm is your brand. I love sarcasm but this is a serious matter.
I’ll show myself out, thank you.

First comment was a bot. Second comment is a human intercession from a troll farm when the bot was unable to cope. All your generic claims to authority are amusing. You should have left the bot in charge since it performed better.

“breathing and living”

I dare you to do one and not the other.

“I dare you to do one and not the other.”

pulls out pocket iECMO boom, baby. power flex.

I strongly suspect Patrick D is a bot (based on structure and content).

This seems to be jumping the gun big-time.

Actually, I’m a concerned respirologist and head of my University Hospital division – breathing and living in Canada.

I am going to call bulldust on that one.

If you had this expertise, you would have been able to drive a truck through the boghouse arguments in the op ed by Risch.

Perhaps you need to recruit Penn and Teller. Ever check out their video on vaccines?

I appreciate the article especially all the links that will help me delve into the literature for myself. This must have taken a lot of work and I think your dedication is commendable. If the information comes with a bit of snark then so be it. I can see that this is for what it is; an entertaining style suited for the internet which generates readership, and for me it makes the message easier to digest.

On the other hand, I do think some of the commenters who criticize the tone have a good point. The sarcasm tends to take a scientific argument into a personal argument which is what seems to be happening in the hyperpolarized political divide. You obviously have a talent for scientific commentary and can bridge the scientific/lay person divide, but based on the comments section, you do seem to put some people off (obviously any scientist recognizes that the comments section is not an unbiased sample of the readership). Even if this has been your brand for 15 years, you could consider modifying your brand slightly to reach more people. Even Coca-Cola changes its labeling every few years. Instead of being defensive and resorting to calling people names like “tone troll,” maybe you should look at the comments as constructive feedback.

From another “concern troll:” I understand the anger of Orac, but I think Patrick D. is right. There is no way to reach the Zebs of the world, (I know from experience–I’ve been trying for years,) They will wade through tons of research, but only to find the parts that support (or appear to support) what they want to believe.

But not everyone is like that.The debunk would have been even better if it had simply explained a few of the many good examples of differences between in vitro vs in vivo results, of species-specific responses, or of reaching a bogus conclusion because a supposed remedy was tested on cells from the right animal but the wrong kind of tissue.

Perhaps so. Those issues have been discussed in many of the articles on this blog as well as articles by a certain person at

But keep in mind that is a blog written in the author’s spare time. It can’t be expected to the level of review and editing that would normally be put into an article for publication for a scientific or general audience.

And this op-ed for Newsweek, a large commercial magazine, could certainly have benefited from such a review.

And gaps such as you mention are frequently filled by commenters noting research such as this article in Nature from 2 days before this blog article.

Finally, I doubt if many readers of Newsweek will even find this blog, much less understand the import of that Nature article.

@ rs:

Truthfully, I would welcome bots instead of the low grade trolls we encounter these days.

Back in primordial times, Narad “created” bots to mock clueless scoffers. Perhaps if we’re nice, he will resume his calling. Maybe along the lines of the Chopra phrase generator?

I just CAN’T react any more.
Where’s Joel?

Perhaps if we’re nice, he will resume his calling.

Oh, no, my time’s running short — five weeks till homelessness, and Dadadodo requires quite a bit of maintenance. The corpus has to get the Goldilocks treatment, and it doesn’t recognize punctuation.

@ Narad

“Oh, no, my time’s running short — five weeks till homelessness”

For fuck’s sake, I just hope you manage to get through that shitstorm.

I hear they are housing ‘homeless’ in hotels there? I’m not really sure that is a particularly humane or ‘good thing’ but you might win some sweet sweet internet karma posting videos of roaches to rival the size of Huntsman spiders of australia? — Also, free wifi (use vpn).

Punctuation is a fith grade construct imposed to shackle the mind%

Hmm. Ladies by the store? Dressed in Satin? Waiting by the door?

I didn’t even know they still had U-totems then. Ahh, the days when a 12 year old could buy menthols for ‘mom’ and Playboy ‘for dad’ because he liked the ‘articles’ {the Yassar Arafat interview was pretty outstanding}…

@ Denice Walter

“Where’s Joel?”

No clue.

I did try to leave a message at an email address that seems to be his. Complete silence. I really dislike this situation.

Anyhow. Took kind of a break on this blog because of my spat with Joel and I’m killing time on a (semi-)far right french blog. Rather tricky to debate with far right people who want to jail almost anyone…

No clue.

Joel was also a contributor to a blog with a certain managing editor.

If you really want to rile them up then make a ‘yo mamma’ joke in a really deep voice so that doppler shift does not make you sound like a girly girl as you run toward them. Afterwards, and If there is enough distance, and you are not too out of breath, I find the punctuating ‘double eagle’ to be most inflammatory to those types.

Does anyone here know if Joel A. Harrison, PhD, MPH has ever professed that he may be an epileptic?? /trepidation

Is it possible that this article, “Chloroquine is a potent inhibitor of SARS coronavirus infection and spread,” published in 2005 in the Virology Journal [] was how the idea of chloroquine and hydroxychloroquine having efficacy against COVID-19 originated?

Chloroquine and hydroxychloroquine have a long history of inhibiting viruses in cells in petri dishes.

Their efficacy in animal models has been meh. The outcome has been no effective treatments against any virus.

It has come as no surprise to me they have proved to be equally meh against COVID-19 in vivo. Was worth trying, but everyone would have been better off if the giant egos had kept out of it.

Perhaps you should apply at Yale to replace this poor misinformed professional .. it sounds like you’ve got your opinions lined up
As Lucy always said … best of luck Smartyboots ..

Just discovered you while searching for info on Harvey Risch story. Ended up thoroughly reading several of you articles. Thank you. I was an early participant in Usenet also.

I’d really like your input on the money involved with Covid, and if it’s possible that hospitals can use discretion to boost their revenues by doing things that also inflate Covid data.

Another area of interest: regional disparity in cases and deaths. I have family in SE Asia, followed daily and figured certain high #s of dead due to disorganization and lack of measures. Cambodia did almost nothing for example, still so. Is it sun exposure? Lack of obesity? Tanzania another example. They’re not wearing masks or doing much of anything – where are the dead body mountains?

Finally one more. This is the massive obedience in wearing masks in king county WA (and others). In April / May almost nobody wearing masks. By late June we see radical shift to nearly100% mask use. There’s huge social pressure and an honest belief that Covid will disappear w/mask use. It has only gotten worse though and we’re 30+ days in. What gives?

Not sure, but I think Africa has a relatively young population, which is less likely to die from Covid-19.

Japan has an older population and has done comparatively well. In looking at the comparative age demographics of several counties, I didn’t see population age as a consistent explanation. So, something else is at play.

Try reading the other articles on this site before you jump in with a request for other people to do your reading for you.

Hi. Yakima is separated from king county by the cascade mtns and about 200 miles, travel not easily between them. Mask use in Yakima is likely less universal. Specifically I am curious about king county where there’s been total, sudden mass compliance for 30+ days. Doesn’t this suggest that masks are at least overrated? It may even be the case that masks, the way they’re being deployed here by the masses, are making it worse for myriad reasons.

You do know that there is a freeway and several highways to drive over those mountains, plus there are trains that go through the mountains and along the Gorge (I highly recommend driving along the Gorge, then following the Columbia River to the Yakima Valley). My family is from Yakima, travel is not onerous. Plus what they grow is shipped out of Puget Sound (much of it used to go to Asia, until politics intervened).

The mountains are not a full out wall. We still get wine shipments from Chelan and Wapato from our two wine club memberships.

King County is much more open than it was a month ago. The neighborhood barbershop is open, The parks are fairly full (lots of people swimming in Lake Washington at Magnuson Park even though there were several signs saying no swimming and no diving). We had an outdoor dinner with some family not in our household yesterday evening (we wore masks when we not eating).

Yakima is now catching up to King County:

Sir I am third generation PNW educated in Seattle schools, grew up spending summers in Chelan and after graduating from two WA state colleges was involved in the WA state tree fruit industry for 5 years. Cherries and apple exports — we probably know same people.

I witnessed a rapid shift from very low mask use to almost total compliance starting around 40 days ago. I mean it’s got to be close to 99% in king county in barbershops and everywhere else. It begs the question. An honest question. Why has the total shift to mask use resulted in increased cases, let alone no drop at all. It can’t be travel from Yakima or kids swimming at Magnussen Park or small social backyard get together. Even with those occurring the massive shift to masks would have some positive results.

An old friend of mine w/severe TDS started going berserk about masks in June saying it’s the be-all end-all solution but selfish people just won’t let it happen. Well he got his masks. It’s impossible to find anyone not wearing them. In my view he represents part of the problem. He won’t admit he was wrong. There has got to be more involved here.


“Why has the total shift to mask use resulted in increased cases, let alone no drop at all.”

Well, you do have the increased testing, which is finding more cases, as Dumbp proclaims. And you have to keep in mind the ‘timeshift’ of what was happening a month ago. Give it another couple weeks and the spike should level off.

Agricultural comminity, huu? Migrant workers living in close quarters? One would need full-time respirators inside domiciles at this point because the virus was so rampant before the masking thing took hold. Are people even wearing anything in the home setting???

I’ve been dreading Italy-style stay inside at this point because of precisly the above. It will make a huge surge and everyone will go “see? masks and lockdowns made it worse.”

Contact tracing and isolating? Pu Leas. That is on the states. Person, woman, man, camera, tv. da lau an da ordur. Argentina and Chile fixed PR problems before, let us do that.

Then don’t say such silly things about access to over half of our state. I gave you links. If you cannot connect to the Seattle Times online, then go buy a copy. The article is several pages long. It would answer much of your questions.

I hope you did notice that the governor brought back more restrictions this weekend.

Then don’t say such silly things about access to over half of our state. I gave you links.

It was only on my fourth try that I managed to internalize the fact that the ferry from Bainbridge to Seattle was free.

You do know that there is a freeway and several highways to drive over those mountains

Who would have known that such things existed? (add emoticons of choice here)

I am finding the arguments being made against management strategies for dealing with COVID-19 to get lamer and lamer.

We have had cases have been going up, but deaths have been going down, so COVID-19 is now less dangerous. Until deaths started to rise again. Do these people not understand that you have to catch SARS-Cov-2 before you can die from it.

This argument that travel between different parts of a state that are linked with Interstates is not easy, just about takes the case for the stupidest bit of whataboutism I have read.

@ SugarFree “Why has the total shift to mask use resulted in increased cases,”

You have put the cart before the horse. The request from the governor to wear masks is in response to the increase in cases and deaths. And that’s not just based on the WA numbers, but on the numbers from the neighboring states. Like Idaho, where there is no mask requirement (or anything else as far as I can tell).

And I haven’t read anything anywhere that suggests that a mere 30 days of OK mask compliance is enough to stop the spread of this disease. The most hopeful I’ve read is 6 weeks, and I think that’s just wishful thinking. So I don’t know why you would expect the infection or death rate in Washington to have suddenly fallen off.

My question is, after witnessing full and total mask compliance in densely-populated King County, a sudden/rapid change in behavior since mid/late June, why haven’t cases gone down. You jump in and talk about Yakima, and seeing this ludicrous aspect because it’s so far removed from King County, I figured you had no local knowledge but turns out you do. Then I’m supposed to read The Times. O—KAY. Yakima. LOL.

The ag workers need support, now. WA and other governors are bumbling responses, not isolating at-risk the way they should, and now not supporting the labor which needs to harvest and pack our food supply. I am in the industry. USDA has a Market News report and you can see wholesale pricing. Buckle your seat belts prices are going nowhere but up the writing is on the wall. At the farm level there’s a lack of labor, at the end-user level our restaurant industry demand has radically shifted, in the middle distributors are struggling

Following a spike in cases, we will see broad results from mask use after 6 weeks? Why 6 weeks? Seems like a long horizon but we are nearing that soon. I’m watching but if you know why it takes 6 weeks that is an interesting fact and I’d appreciate why such timeline exists. About Tanzania, it’s all of Africa actually. Massive crowded areas with total disorganization and heavy influx of Chinese in recent years (well documented). No piles of dead bodies, and you know the media would be all over that. Tanzania is one of the more civilized countries, and I know someone from there. It can’t be ignored, same as the other countries I mentioned. Regional disparity in cases and deaths would seem to be key in resolving Covid.

Doesn’t answer my question in the slightest.

Doesn’t answer my question in the slightest.

That’s because I wasn’t responding to you.

About Tanzania, it’s all of Africa actually.

That hasn’t reported numbers since the beginning of May?

Massive crowded areas with total disorganization and heavy influx of Chinese in recent years (well documented).

Jeezums. What, the Chinks seeded Africa over “recent years”?

Tanzania is one of the more civilized countries, and I know someone from there.

I think this remark speaks for itself.

Here is the data. I have a few other things to tend to before getting to the subnational population data, which is in one of these windows.

You might have better luck trying at ScienceBasedMedicine. There is a much larger number of qualified participants in the comments.

Also, I made the comment in regards to the county with the highest per capita number of cases. The point is no county is an island, not even Island County, there is travel between them all. Hence, the virus will keep getting transmitted.

And truthfully you statement of the isolation of the eastern part of state reeked of someone who would think Seattle is located on the Pacific coast not realizing there is a another body of water and even another mountain range in way.

@ SugarFree “Tanzania is one of the more civilized countries, and I know someone from there.”

Well, that was racist. And you described Africa as though it’s some monolith. Racist and lazy. (As though civilizations haven’t flourished in Africa for millennia.)

Look, I get it, you don’t want to wear a mask. And that’s why the numbers in King county aren’t dropping any faster – because of people like you who won’t wear a mask.

If you won’t wear a mask at least have the decency to go dive yourself a bunker in the Cascades and leave the rest of us alone.

@ SugarFree,

Does SE Asia/Cambodia/Tanzania have annual influenza vaccine campaigns?

It must be vaccines, because to you and your kind it is always the vaccines.
Perhaps one can ask the same question about India and Brasil, 2 countries where the number of infections are still goinig up.

Besides, I don’t understand why you are so opposed to vaccines, which work and in favor of HCQ, which doesn’t work and have considerable side-effects.

I’d really like your input on the money involved with Covid, and if it’s possible that hospitals can use discretion to boost their revenues by doing things that also inflate Covid data.

Have you ever had one of those times when you wish you could express yourself in predicate calculus?*

Let’s take on the worst-case scenario, viz., imposing symmetry: Covid data is inflating itself to do things to boost hospital revenues† on a discretionary‡ basis.

† Ummm, overtime. Genius!
‡ This is where you imbue it with agency.

If Tanzania doesn’t have many cases, then why are they working with an American non-profit for resource-appropriate ventilators?

Also, do most of the people of Tanzania live in the major cities, or are they more widely dispersed in the countryside? Since that would have an impact on contact rates and therefore disease transmission.

Tanzania does not have many cases, because on May 8 they suspended all reporting of COVID-19 cases.

SugerFree asks many of the same questions I ask! Bad incentives in US hospitals-are they real? I look at the various countries and am bemused at variation i see in infection and death rates. Also: Risch seems to dismiss the risk (and, as I understand it, H is given out like candy to those traveling to malarial areas) while others scream about side effects. Who’s right? And…should we really ban it if it is harmless and some docs want to administer it? Wish Trump would not have mentioned this drug…bias now throws sand in my eyes every time I try to figure out what is going on.

The French HCQ study that Didier Raoult co-authored had gross methodologic deficiencies and was “fully irresponsible”, according to a review. From Retraction Watch:

“A March 2020 paper that set off months of angry debates about whether hydroxychloroquine is effective in treating COVID-19 has “gross methodological shortcomings” that “do not justify the far-reaching conclusions about the efficacy of hydroxychloroquine in Covid-19,” according to a review commissioned by the journal that published the original work.

The comments, by Frits Rosendaal, of Leiden University Medical Center in the Netherlands, came as part of a review commissioned by International Society of Antimicrobial Chemotherapy (ISAC), which publishes the journal along with Elsiever. ISAC had issued a statement about the paper in April, saying it “does not meet the [International Society of Antimicrobial Chemotherapy’s] expected standard.”

Zinc anyone? With Hydroxychloroquine, it appears to be essential in countering continued infection by the Wuhan coronavirus as it attacks via the ACE2 receptor. Azithromycin is a greater threat for heart arrhythmias – find a substitute.
First do no harm! This article attacks Dr. Risch’s learned observations with harmful intent.
Hydroxylchloriquine has been in use for 65 years with no mention of heart arrhythmia concerns until recently and was identified as effective remediation for SARS 1.
Data is coming in which shows that where it is freely distributed, deaths rates from Covid 19/SARS2 are less. Mounting anecdotal evidence and studies demonstrate the effectiveness of Hydroxychloroquine in treating Covid 19/SARS2 – especially in pre-ARDS patients. Ventilators meet with little success in treating Covid 19/SARS2 related ARDS. Still using them aren’t we.
ORAC fights a silly battle while people are dying from lack of Hydroxychloroquine. Risch saw the light.
ORAC – previous ARDS studies demonstrated nebulized tPA restored fibrinolysis balance and oxygenation levels. March 2020 MIT article based on autopsies noted coagulation effect of Covid 19/SARS2 and lung, heart, etc., failures and suggested tPA. Mt. Sinai used tPA in small study, but supplemented with Heparin. What blood thinners are now best for treating coagulating effects of Covid 19/SARS2 arrhythmias?
Are you blaming Hydroxychloroquine for arrhythmias when Covid 19/SARS2 may be the cause? Hydroxylchloriquine only stops continued infection apparently. As a prophylactic or pre-ARDS treatment, Hydroxychloroquine or Dexamethasone are the readily available, cost effective methods to prevent more serious complications from the Wuhan coronavirus (Covid 19/SARS2).
I am not a doctor, but you are. Petty arguments abound, but your professionalism should protect you from a jaundiced view which you apparently have been infected with.
Step back! Heal thyself!

@ CJones1

“First do no harm! This article attacks Dr. Risch’s learned observations with harmful intent.”

The most ridiculous juxtaposition of sentences I’ve read in a long time.

“I am not a doctor”

Luckily not. You do not understand what “Do no harm” means.

“but you are.”

Luckily not. I’d delight in harming assholes.

“Petty arguments abound, but your professionalism should protect you from a jaundiced view which you apparently have been infected with.”

Orac’s professionalism is pretty much untainted. Protecting patients by shielding them from a shitstorm of bullshit is pretty much essential to the “Do no harm” mantra.

“Step back! Heal thyself!”

I’d suggest a brain transplant. For you.

I love when people refer to it as the “Wuhan” virus, because it’s an immediate tell that they’re a racist conspiracy theorist and I don’t have to read the rest of their comment.

Lol, the lawyer has been described as

Klayman, the founder of the Judicial Watch, is “a pathologically litigious attorney and professional gadfly notorious for suing everyone from Iran’s supreme leader to his own mother”.

The coronavirus crazy is flowing fast and furious these days.

The Journal of Public Health), a peer-reviewed Springer journal, somehow has let through a paper by two Greek engineers and a dentist, “Homeopathy Combat Against Coronavirus disease (Covid-19), published in Junep. It shows that homeopathy works (because Math) and so public health agencies should urgently investigate homeopathy to treat Covid-19. A co-author of the paper says:

“The results of our research showed that homeopathy is something much more than it seems. Classical homeopathy broke the timeless mistake made by established medicine in therapeutic. This mistake is related with the linearly approach of disease, which as a phenomenon is non-linear. The results’ phenomenology from the applications of classical homeopathy is fully supported by mathematics. Because they are unpublished works I cannot tell more. Today, when humanity is being severely tested by Covid- 19 and no effect has emerged, except from the thousand’s dead peoples every day, the correct application of classical homeopathy by professionals would be an oasis.”

So there, skeptical persons.

No pesky handling of gross or poisonous stuff required here, this can safely be prepared and studied* in one’s own home environment.

Like cures like, right? And this coronavirus kills by ‘dry drowning’. So, logically,

(1) take 17 silica gel desiccant packs (“do not eat” should be clearly visible on the wrapper) and drop them in 473.176473 ml of distilled water

(2) perform a 12C dilution

(3) inhale all the water

*If you don’t die of covid-19 (and you won’t) then please consider posting it to facebook for scientific posterity.

“Classical homeopathy broke the timeless mistake made by established medicine in therapeutic.”

“This mistake is related with the linearly approach of disease”

“and no effect has emerged, except from the thousand’s dead peoples every day”

The F2P version is not very good. Is it.

They left this bit out of their equations.

Yah, but they duplicated others to make up for it. And either this was submitted on paper, or the paragraph-by-paragraph notational miscegenation suggests that this was a very poor pastiche.

And Lampaport doesn’t help.

Then there was this

5G causes 720! (factorial) different diseases in human beings, and can kill everything that lives except some forms of microorganisms


I would be dumbfounded, but this effort is too dumb for that.

…..and a thousand grammar teachers suffered heart attacks after reading that quote, Dangerous Bacon!

@ Renate,

"It must be vaccines, because to you and your kind it is always the vaccines.
Perhaps one can ask the same question about India and Brasil, 2 countries where the number of infections are still goinig up."

And Brazil has higher flu vaccine uptake than the US does; 70%.,and%20have%20high%20media%20involvement.

India’s deaths per capita is 24 The US is 452. Brazil is 409.

Australia was under 200 cases per day since April 3rd. From April 23-June 27th, their 7 day moving average was under 30 but their flu vaccine campaign also started in June. June 29th, their daily case rate went to 81 & their 7 day moving average is now 337.

So I asked a valid question.

"Besides, I don’t understand why you are so opposed to vaccines, which work and in favor of HCQ, which doesn’t work and have considerable side-effects."

I’m not in favor of HCQ; yet. There isn’t enough information available. I am opposed to vaccines because my daughter died less than 24 hours after vaccination & I suspected that my son was permanently disabled by them & has severe, regressive autism after he was inadvertently given the DPT & MMR on the same day, along with “catch up” doses he missed during a strep infection. He has now been diagnosed with an immune disorder similar to PANDAS, has zero antibodies left from any of his immunizations & is now exempt from vaccines. I believe this is happening to way more people than is being reported.

India’s deaths per capita is 24

This may well be the dumbest fucking thing that has oozed out of your head to date.

@Narad, the sad part is that CK claims to have worked as a nurse. The idea of someone that intellectually sloppy setting up IV meds or handing out pills is terrifying. It would be a miracle if she didn’t seriously harm someone during her career.

“India’s deaths per capita is 24”

No, no. What she meant was… aaand, I’ve got nothing. FU AWS.

No kidding. That’s the deaths per million. More to the point, the case fatality ratio for India is currently 2.3% vs 3.47% for the U.S.
Italy had 14.3% because the elderly population was hit so hard and hospitals were overwhelmed.

You wrote wrote paragraphs of text about nonsense. you think the one thing that spreads covid is the amount of vaccines % a country has. first of all a simple google search and i have hundreds of sources that show that vaccines stop diseases and how important they are

do vaccines cause autism all the research says that it does not IE another article from a different source Honestly i have never heard your theory from anyone except you. I wonder where do you get the idea that vaccines cause covid-19. Do you have some sort of god complex where everyone else is wrong except yourself? Please watch this clip from John Oliver where he goes over conspiracy theory and also explains causation does not = correlation finally if vaccines is what cause covid-19 why not look at countries that have high vaccine rates like South Korea that was able to beat back the Covid.

I don’t know if you are just trying to troll or are serious but there are too many idiots in this country and you seem like a well written person. I am not scientist but i cant stand people who make crap up and have no one dispute them.

Actually, Australia’s influenza vaccine campaign commenced in March, peaked by the start of May and was effectively done by the start of June. I feel the need to correct made up statements.

“I am opposed to vaccines because my daughter died less than 24 hours after vaccination & I suspected that my son was permanently disabled by them & has severe, regressive autism after he was inadvertently given the DPT & MMR on the same day, along with “catch up” doses he missed during a strep infection.”
True story: My sister died less than 24 hours after my niece’s high school graduation, and my other niece (a hospital worker) was diagnosed with Covid-19 less than a week after completing her internship program. Clearly education is to blame, and the schools are part of a conspiracy of DEEEAAAATTTTHH!!

Addendum (Where is that Crappy Poem Filter when you need it??):

{That sad song on banjo lends itself to being personalized and continued as ballads sometimes are by whomever is singing them, so I gave it a shot}

But as the flood came to pass and destruction news was plain,
a friend of hers had read his water-dead name and remembered it.

So he went to his place while still in the rain
and let himself in through the window pane,
and looked around.

Under a pile of junk in a rough wooden crate
was a silver-looking bag with a sliding latch plate
that held a gold-colored one-shot digi-camera.

He powered it up and the first screen said
(with a few missing letters ’cause the battery was dead)
“Press the B key now, to unlock it.”

A single cherished image of a happy scene
by a gnarly-rooted tree with a knotted rope swing
flickered to life,
on the screen.

He was found by the river on the other side
of where his spirit in the image of the picture

dwelled, and died.

He knew the weather didn’t get him ’cause he knew the river well
And he’d been wondering
just how he really fell

and why so alone.

He staired at the image for a good little while
and as the camera began buzzing and the picture started fading
he went to smiling and upon her cheek he layed, a goodbye tear.

He loved that tree,
as did he.

So now he knows
what stopped his heart.
He’d been down on his knees in the stinging breeze
with his outstreched arms and his pleading pleas
while the raging rampart swelled.

He’d been powerless to help so he never got up
as he’d watched his love be felled;
From the otherside, across the river.

{Is 2020 over yet? I think not. And that makes Timmeh sad.}

Once again, Christine klies. What the article actually says: “Experts have pointed to India’s relatively young population as a possible explanation for the lower mortality rate, as the young are less susceptible to dying from coronavirus.”

Christine’s claim that her son has a disorder similar to PANDAS and thus is “exempt from vaccines” runs counter to good medical practice. From Vaxopedia:

“Children with PANS and PANDAS should receive standard childhood vaccines, following recommendations from the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians (Centers for Disease Control and Prevention 2016a). The patient and all family members should receive annual influenza immunization as described under Influenza (described earlier).”

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections

PANDAS is caused by an abnormal immune response to streptococcal infection, not vaccines.

CK’s belief that she is a complete vaccine non-responder is, in the absence of a known, documented immune deficiency disorder, probably cut from the same imaginary cloth.

I suspect that she didn’t name her son’s supposed diagnosis because it’s not recognized by most non-quack medical practitioners., or because it’s known not to have anything to do with autism. I’ve noticed many antivaxxers seem to have trouble with the concept of comorbid conditions, and are always trying to seek “the root cause.” It matches up with their claims that vaccines can cause about 100 different conditions that look nothing like each other.

The root cause is the Big Bang. It’s responsible for whatever ails you. There is a cure but it’ll be a long time coming.

@ DB,

He is vaccine injured & exempt. PANDAS is not his only immune related diagnosis. I know what PANDAS is & the vaccines that initiated his regression were the ones held initially due to a strep infection.

What are the odds that “He is…exempt” means “I refuse to have him vaccinated” or “I found a quacky practitioner to grant a bogus vaccine exemption”?

So.. we have guy one saying one thing… guy two saying something else…

Is there ever a point where we find out what the truth is?

Asking for a world that desperately needs the truth…

No, we have one guy saying one thing that he backs up with misinformation, bad science, and bad logic, and we have an other person refuting that misinformation, bad science, and bad logic.

You’re welcome.

Translation: my guy is right and your guy is wrong.

You’re welcome (see, the smugness shows how smart I am).

@ DB:

What level of activity would determine whether one is a ‘BS Super-spreader’ or not?

Would one need to:
— make documentary style films/ videos about the autism/ vaccine connection?
— sell products ( books, supplements, foods) that address issues related to the supposed autism-vaccine connection?
— maintain/ support a highly trafficked Face Book page discouraging vaccination?
— own/ sponsor a charity that solicits funds to disseminate misinformation about vaccines/ autism?
— tweet nearly exclusively about vaccine injury and pharma/ governmental malfeasance?
— comment repeatedly on sceptics’ blogs to discourage vaccination by repeating misinformation or supplying confabulated reminiscences?
YOU tell me.

I agree with your criteria, and would also add “supplementing antivax activities by appearing on Sinclair TV stations spouting drivel about Fauci inventing Covid-19 in a lab and shipping it to China”.*

*Judy Mikovits

The stuff about Switzerland by Risch is completely worthless. Take a look at the actual death numbers for the time described. They just show random noise, plus a couple of spikes that are clearly corrections.

You missed the best part about his Brazil and Switzerland claims. His claim about Brazil’s death rate “plummeting) to 1/8th what it had been? It dropped from (and I’m going from memory, please allow for a few percentage points error) 98.6% to 12%. On a disease that we know 80% will recover from with bed rest, fluids, and some tylenol. So either he thinks Brazilian doctors were so incompetent that not only were they not helping patients, they were actively murdering them, or perhaps maybe Brazil went from only diagnosing the absolute worst cases as covid and got a lot better at recording actual infections, even the milder ones? Maybe? I don’t think it takes a coin toss to decide which one to go with here, and I’m sure he was well aware this was the case, but since it didn’t fit his narrative, he ignored it, just like he ignored that 12% was still a way worse CDR than countries who didn’t use HQC (they are supposedly down to a 5% CDR, but I don’t trust Bolsanaro’s numbers at this point).

And he was even more intellectually dishonest with Switzerland. On May 27th they had 3 deaths that day. And yes, roughly 2 weeks later, on June 9th, they had 11 (so yeah slightly less than 4 fold, but close enough). Of course he deliberately leaves out that that day was a statistical outlier, and that entire time they had so few daily deaths that even with the 11 death day thrown in there, the 7 day average daily death toll pretty much hung at 2-3 deaths per day, so in reality there was NO increase in in deaths.

This piece of shit knew god damned well he was misleading people with this op-ed. This isn’t simple incompetence, it was deliberate lies by omission, and I think Yale needs to step in and if not formally censure him for this, at least put out a formal statement that despite his prominent exploitation of the prestige his job title and school connection gives him, they do not support the statements he made in the article. Anyone got any contacts at the university to get this ball rolling? I doubt they’ll take an email from an American IT guy living in the UK too seriously, but someone needs to get them to respond to the fact that he used the school’s image to lend credence to this tripe.

When Risch cited the Swiss “data” it was so obvious that he was massively biased and getting data from shitty blogs. The Swiss HCQ ban occurred at the same time as France, Italy, and Belgium. There was a total of 17 deaths in Switzerland over that time frame, and the time period before and after has only one or two deaths per week in the country. If banning HCQ was so obviously detrimental then there would be similar spikes in deaths in France, Italy, and Belgium, but of course he doesn’t discuss that at all.


Just connect the dots: there’s political gain in resurrecting this drug – at least in some minds – before Nov. Good Lord. (Scroll down to the interview in the following link. Surprise!)

Newsweek has been around for more than 80 years and had (past tense) credibility. Its new chief content officer, Jonathon Davis and wife Tracy (president of Olivet College) control a “news” platform with 30 million readers (more about Newsweek here: )

There are better studies on the anti-HCQ side so far but why does it matter if Newsweek published this, that goalposts are moved if the evidence exists, and that Google took down the doc? Venom may be your style but it occludes your thinking. Now do try to not petulantly froth at the mouth – what do you think of the Ford study? Argue well and I’ll agree. Badly and I’ll shred you.

In his response to Dr. Korman, Dr. Risch cites conspiracy theory website No, I’m not joking. A professor of epidemiology is citing Some “article” about how pharma companies are suppressing HCQ because they want to profiteer off of COVID-19.

Seriously, this is what happens when grandpa becomes a Trump supporter.

Risch’s HCQ op-ed is featured on the global website, along with articles hyping nonexistent vaccine dangers, attacking water fluoridation as “poison” and saying genetically modified foods are a depopulation scheme:

“Sterilization from GMOs is not an accident. Henry Kissinger, the protégé of the Rockefeller Foundation and one of the driving forces – still today – of the Bilderberg Society, not only is the author of the infamous proclamation in the early seventies:

‘Who controls the food supply controls the people; who controls the energy can control whole continents; and who controls money can control the world;’

he also said,

‘Depopulation should be the highest priority of foreign policy towards the Third World.’”

There’s so much crank magnetism on that site, that when I went to it, a bunch of loose pins and paper clips on my desk attached themselves to the computer screen.

Henry Kissinger, the protégé of the Rockefeller Foundation

In related news, I started the original “Rosey Grier’s Needlepoint for Men” FB group, which, although sparsely populated, seemed to attract a ragtag bunch of comrades who really thought that it patched some sort of psychic lacuna, as it did for me.

The whole thing is a waste of time. The death rate data is spurious at best, and uncorrelated between the nations. There is no central methodology of data collection, and it appears that there are great exaggerations in both the death and case rates. More people died from the flu last year, and many more died from the Hong Kong flu many years ago. In Australia, where I live, deaths from all causes to date this year are about 100,000. Only 200 of those deaths are C-19 related, and for this we destroy our economy and ruin people’s lives. Absolutely absurd. More than absurd. It is paranoia.

Why are you only talking about the death people and not about those who need long hospital care, which also is an burden to economy? And don’t forget people who are suffering from all kinds of problems, like having lungproblems, other organs that can be damaged, loss of all sense of smell and taste and generally not being able to function like they were before they got the disease. Also things that can have bad financial consequences.

@ John Duval

200 covid deaths in Australia. 680’000 worldwide. And that’s likely both underreported and not the end of it. I personally do not mind people dying, but 200 versus more than half a million, that’s more than lying by omission: a pandemic is not a national matter.

I do not believe the economic evaluation of what has been undertaken during this pandemic is mightily sensible. But get real: if we had claimed, at the beginning of the pandemic that we’re going in for more than half a million deaths with glee while doing nothing, everyone would have accused our governments of being heavily irresponsible. It’s therefore pointless to complain about the inevitable: lockdowns and such.

Now, in 5 to 10 years, we’ll be able to have a clearer look at the overall impact of the lockdown in economic, social and geopolitical terms. Only then will you have, eventually, some data to argue your case.

The death rate data is spurious at best

You don’t say.

and uncorrelated between the nations.

What sort of “correlation” are you looking for?

There is no central methodology of data collection

Do go on.

and it appears that there are great exaggerations in both the death and case rates.


More people died from the flu last year

Therefore, one should not wear a motorcycle helmet.

and many more died from the Hong Kong flu many 42 years ago.

Right-O. That sound that you hear is New Zealand laughing at you.

I have never wasted as much time as I have reading this pile of bullshit..

You must be an extremely slow reader.

@JustaTech and others. Observing that mask usage is 100% in King County is not proof that the observer doesn’t wear one. I don’t go anywhere without a mask, and neither does anyone else. Where are the tangible results?

Much of Africa is uncivilized, it just is. Look at any global agency survey of sanitation, record keeping, building standards, hospitals, roads and public education — the internet is loaded with reports such as these. Tanzania has a sizable community of ethnic Indians who control most of the economy.

The good doctor here has made a critique of a Yale professor and I ask some relevant questions only to be met with ‘but you don’t know about Yakima’ and ‘racist’ and ‘you just don’t want to wear a mask’.

Wondering if the quality of responders doesn’t correlate with that of the domain owner.

This article is full of harmful disinformation. The Lancet study was retracted because it was based in fabricated, invented data. ALL the studies claiming hydroxychloroquine was dangerous of ineffective used potentially lethal dosages of hydroxychloroquine that killed some sick persons and gave serious side effects to well persons. The same dosage of 2000 mg spread evenly over 5 days that is used for malaria, rids the body of SARS-COV-2. The murderous studies that gave potentially lethal dosages of over 1500 to 2000 mg of hydroxychloroquine within 2 days or gave well over the suggested maximum of 3200 mg altogether never tested for viral load and so never tested to see if the participants dies from COVID versus from lethal overdoses of hydroxychloroquine. Most of these murderous studies dosages were designed or suggested by WHO. All these murderous studies did was prove that if you give known lethal dosages of a drug to patients, they may die! See and follow all its links to supporting data and detailed information.

Funny how you’re only discussing the negative observational studies. What you claim is not true of the multiple randomized controlled clinical trials that Prof. Risch ignored. Also, guess what? RCT evidence trumps retrospective observational studies like the Henry Ford Hospital study.?

Harvey Risch doubles down here (Aug 23rd):

(2:10 – 4:30)

His claim (paraphrasing slightly):

The evidence is overwhelming…there is no question…in people who need to be treated (later in the interview he says these are people who are over 60 years of age AND people with risk factors such as obesity) AND are treated early, [HCQ] has a substantial benefit in reducing risk of hospitalisation and mortality. The evidence is all one-sided…stronger than anything I have ever studied in my entire career.
All the negative studies are those done either with hospitalised patients who are very sick, or in patients under 60 with no risk factors.
All the studies done in those over 60 or with risk factors who were treated early show benefit.

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