Tag Archives: hydrochloroquine

The Rationale for Not Using Hydroxychloroquine and Azithromycin to Treat COVID-19

Medical Treatment, Toxicology/Drugs, Public Health, Infectious Disease, , , , , , , , , , , ,

Introduction

Before looking at the rationale against the use of hydroxychloroquine and azithromycin to treat COVID-19, think about what’s being asked here. There are two option. The first is you’re potentially asking for a patient requiring critical care to benefit from a miracle cure. The second is you’re asking for an antiparasitic medication with a dangerous side effect profile to work in preventing the spread of an especially virulent virus in patients who mostly recover on their own. It’s as if the cards were stacked at the beginning of the conversation. In case you haven’t done so, review the previous post on the rationale for using hydroxychloroquine and azithromycin.

There’s a difference between hope and false hope. To quote Dr. Fauci’s comments on physicians and persons endorsing this combination without evidence, “We don’t operate on how you feel. We operate on what evidence is, and data is…we’ve got to be careful that we don’t make that majestic leap to assume that this is a knockout drug.”

Meanwhile, President Donald Trump, in his self-described capacity as a cheerleader, has notably encouraged using these drugs, saying “What do you have to lose?” Well, physician don’t operate that cavalierly with your lives. We operate under the mantra “Do No Harm.” Let use these opposing premises as the starting point for a review of the arguments against the proposed uses of hydroxychloroquine in treating COVID-19.

The Research

There really are four topics that constitute the arguments (“evidence” if you will) for use of hydroxychloroquine in treating COVID-19. Let’s review them.

Small studies performed on laboratory cell cultures

A Chinese study demonstrated that hydroxychloroquine prevented proliferation of the COVID-19 in a lab setting. Anyone who has ever taken a high school science course should recall the difference between in vitro and in vivo. What happens in a petri dish is a long way away from having the same effect on and having benefits in living beings. Furthermore, efforts specifically meant to replicate the lab (in vitro) success have not been successful. Per the academic journal Antiviral Research: “Chloroquine has been proposed several times for the treatment of acute viral diseases in humans without success.” Simply put, the drug has shown no benefit when tested on any animal in clinical studies.

Comments of Chinese Health Officials

Chinese health officials assert “chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome.” That sounds good, but this Chinese consensus statement provided no data to support the assertion. For example, one such paper was titled “Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies.” It cites as its primary source an audio recording of a news briefing from the State Council of China. That’s propaganda, not science.

The French Study

A single French study that suggested the combination of hydroxychloroquine and azithromycin was effective against COVID-19. (This is the study Trump references in his tweets.) The study’s conclusion states “hydroxychloroquine is efficient in clearing viral nasopharyngeal carriage of [the novel coronavirus] in COVID-19 patients in only three to six days, in most patients.”

This paper has been criticized widely. Here are some of the cited concerns.

The study contained 20 people, thus lacking the statistic power to make extrapolations of the data that supporters have made. Also, this study was published without underground the peer review process that subjects these things to medical scrutiny.

This was not a double-blinded study. The doctors and the patients were aware of patients’ group status within the study. This is a failure by itself. Also, only a quarter of the placebo patients actually had their viral load measured! So how was the conclusion of reducing nasopharyngeal COVID-19 quantified? By the way, even if “clearing of the virus” occurred, that doesn’t necessary equate to “better clinical outcomes.” There is no suggestion one set of individuals fared better than the other.

Furthermore, six (a pretty substantial proportion) of the patients from the group who had been receiving the drug quit the trial. Three of them ended up in intensive care. One died. These likely were failures of the drug to work against the virus, but this data wasn’t considered or reported as such in the results.

Dr. Vladamir Zelenko’s 699 Patients

Many are enamored with Dr. Vladamir Zelenko’s claims that he has treated 699 patients successfully with hydroxychloroquine and azithromycin (with zinc). Here’s all you need to know to analyze his efforts. Zelenko’s claims are exactly that: claims. He has published no data. He has described no study design. There has been no analysis reported. His anecdotes are not close to being scientific proof.

Pushback

In fact, there has been an actual controlled clinical trial from China that showed no statistical differences in health outcomes between a control group and patients who received hydroxychloroquine after seven days. However, because of its small size, it also can not be deemed conclusive.

Still, and in case you didn’t know, the preponderance of evidence (or lack thereof) has compelled the Centers for Disease Control and Prevention to pull back its guidance for hydroxychloroquine usage for COVID-19. It no longer offers recommendations for its dosage. Also, the CDC has also deleted all information on those aforementioned early studies of the drug from its website. Its “off-label” use for emergencies is left to the discretion of individual physicians. It is of note that multiple prominent institutions, such as Northwestern Memorial Hospital in Chicago, have declined to offer it.

Summary

What this all means is, at best, “the absence of evidence isn’t evidence of absence.” It is indisputable that the research thus far is below the medical and scientific standard. However, because of some of the theoretically plausible benefits and the actual absence of any meaningful data, the drugs are worthy of undergoing the scrutiny of the scientific method of research. And thus, legitimate clinical studies have begun.

It is unfortunate that the attention paid to hydroxychloroquine and azithromycin (and their unfounded positioning as miracle drugs) could be distracting from other possible solutions. It certainly is a distraction from the need to focus on wider testing and preventive strategies. What has also been lost in the fervor is the combination of hydroxychloroquine and azithromycin could be dangerous for individuals, particularly those with some heart conditions. However, you will note that looking at side effects wasn’t even necessary to demonstrate the use of these medicines is premature at best. In the spirit of “do no harm,” let’s finish back with Dr. Fauci, who was asked if he would take the drug if he were stricken with the virus. His response? “Only if it were part of a clinical trial.”

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Order are now at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

Follow us!

Feel free to #asksterlingmd any questions you may have on this topic. Take the #72HoursChallenge, and join the community. As a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Receive introductory pricing with orders!

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The Rationale for Using Hydroxychloroquine and Azithromycin to Treat COVID-19

Infectious Disease, Toxicology/Drugs, Respiratory/Lungs, Public Health, , , , , , , , , ,

Introduction

This is the first of a two-part Straight, No Chaser view at the rationales for and against using hydroxychloroquine and azithromycin to treat COVID-19.

Perhaps the distraction of the US President trumpeting (no pun intended) this combination has turned some away from the possibility that these medicines could be helpful. Maybe the well-publicized deaths of individuals taking the medicine has caused concern. Perhaps the robust criticism of the most-commonly cited study used as evidence has led many in the medical and scientific communities to be dismissive. Still, there has to be scientific reasons for putting forth the medications and the combination, right? In fact, there are.

Hydroxychloroquine and Azithromycin

Let’s review the ways the drugs work and the scientific rationale for their use against COVID-19.

Hydroxychloroquine

Hydroxychloroquine (HC) is a derivative of an older drug (chloroquine). Both drugs are best known as drugs used to treat malaria, which is a disease caused by a parasite spread by mosquitos. HC has the following properties as a drug:

  • It disrupts the ability of parasites to reproduce and proliferate by blocking a chemical needed to digest proteins. It’s basically starving the parasites. This mechanism doesn’t appear to have applicability in viruses.
  • Even though HC is not an anti-viral medication, it has effects that could combat the way viruses in general replicate, thus slowing its spread.
  • There is evidence that HC inhibits cells’ ability to secrete substances known as cytokines. This is relevant because one of the most devastating effects of COVID-19 isn’t found in the activity of the virus itself. It’s the immune system’s response to the virus. In severe cases, there’s an overreaction by the immune system within the lungs by these cytokines. This by itself can cause fatal damage. This concept should be familiar to those with autoimmune diseases. Sometimes the body is just so exuberant in attacking foreign agents within us that damage occurs to us in that fight. Therefore, if HC activity blocked that cytokine release process, it conceivably would be helpful.
  • COVID-19 appears to bind to hemoglobin, the molecule that transports oxygen. COVID-19 seems to force hemoglobin to release its oxygen molecule. This reduces oxygen-carrying capacity, which ultimately contributes to feelings of shortness of breath. Most importantly, the lack of oxygen within the body’s cells contributes to their death. Furthermore, that unbound iron is a free radical and oxidant. In this state, it causes damage to lung cells (wanting to avoid this process is why so many of you take “anti-oxidants”). Hydroxychloroquine appears to inhibit the binding of COVID-19 to hemoglobin, theoretically reducing much of this.

Azithromycin

Azithromycin is an antibiotic, meaning it is used against bacteria. You likely have taken it and know it as a “Z-pack.” It does not work against viruses. However, there are many situations in which a viral infection lowers the body’s immunity, and bacterial infections take advantage of the situation and “jump” on you. These are called secondary bacterial infections or co-infections. In these situations, azithromycin could be of use because it’s treating the secondary infection.

The Combination

There is actual case history for the use of hydroxychloroquine with and without azithromycin. It is used in China, South Korea and a few other countries. In fact China asserts that chloroquine might improve the overall treatment’s success rate and subsequent outcome, along with shortening hospital stays. Also, there are scattered physicians in the US who have (in)famously cited miraculous success using these drugs.

Summary

Many of those in the pro-camp for the use of these drugs also cite various studies that have shown promise for the use of these medicines. However, as we’ll discuss in the next Straight, No Chaser, those studies actually are support against the current use of these medicines. However, one recalls that penicillin was discovered on a mold that was stopping bacteria from growing on a petri dish.

Even with the theoretical benefits of these drugs having nothing to do with direct anti-viral properties, the indirect efforts are sufficient to suggest that robust research should be conducted within the medical tradition to establish if and how these medicines may be used in patients with COVID-19. It is not inappropriately hopeful to think hydrochloroquine could have a role in the more severe patients. Its indirect effects may prove to be a means of slowing down the march of COVID-19. It is most correct to say that there is insufficient evidence to advance its use, either as prophylaxis or treatment. It is equally important to note that all such evidence is either theoretical or anecdotal.

To that end, in late March, the WHO announced that hydroxychloroquine was among four treatments being analyzed as possible tools in this fight. There is a lot more to come and to be said.

The next post reviews the case against the use of hydrochloroquine and azithromycin in patients with COVID-19.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Order are now at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

Follow us!

Feel free to #asksterlingmd any questions you may have on this topic. Take the #72HoursChallenge, and join the community. As a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample what you can get from http://www.docadviceline.com. Please share our page with your friends on WordPress! Like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.

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