"I knew everything. I knew it could be horrible and I knew it could be maybe good….I don’t want to be a negative person. I’m a cheerleader”
-Donald Trump
“What do you have to lose?”
-Donald Trump on using Hydorxychloroquine with Covid patients
“I am all for everyone having a voice; I just don't think everyone has earned the microphone. And that's what the Internet has done.”
-Aaron Sorkin
“Well I guess today is home ‘make your own mask day’”
-Colleen Dobbs
There are all kinds of aliments in the world and countless treatment options. One of the things doctors have to do is try to look at the unique situation with each patient and judge treatments that have evidence that work to relieve the suffering.
In the United States there is a government organization that is charged with approving pharmaceutical therapies called the Food and Drug Administration or FDA. For a given drug to be labeled FDA approved, it must undergo rigorous testing for safety and efficacy. Since its inception the agency has significantly protected the American public from sham treatments that use to be rife in medical therapies.
Occasionally, and with great caution, doctors may use medications that are ‘Off label” for their proposed indication. This is usually only done when there is a significant body of evidence showing efficacy and other approved therapies would not be as helpful. Doctors and pharmacists deal with this issue on a daily basis for a myriad of conditions. Careful documentation and precise indications are needed to make such a choice. When the physician takes this step he/she must carefully document their rationale or they will be subject to significant medical/legal risk. You do not want to hurt anyone
A physician is charged with the mandate Primum non nocere — ‘First, do no harm’. The phrase is central to the Hippocratic Oath all of us take when we become doctors. Our treatments should never make the problem worse and cause harm to the patient.
It is the ‘Do No Harm’ maxim that is central to the controversy over the use of Hydroxychloroquine in the care of Covid -19 patients.
As of today, this ‘off label’ status is where Hydroxychloroquine use in Covid patients resides. Unlike other ‘Off Label’ medications, the body of evidence used to support the medication is slim at best. Almost all of the evidence of its use is anecdotal. A physician used the drug on a patient and they got better without a significant side effect. That is not evidence of the drug working. It is random chance.
It is a little like saying I have crossed the street wearing green pants without being hit by a car. Therefore it is safe to cross any street without fear as long as I wear green pants. This kind of thinking is largely how the vitamin and herbal treatment industry sells it’s products.
For a drug to be proved to be effective it needs a type of analysis called a randomized blind control study. Basically this means you take a large population of patients and split them in two. One group you give a sugar pill and the other the actual medication. Neither the doctor or the patient knows what medication they are given. Then, we wait for the results.
A portion of the sugar pill population will get better despite receiving a sham medication. This improvement is known as the “Placebo” effect. The real medication group has to show an improvement beyond the placebo effect to show that the medication makes a significant difference.
As of this writing, no verified studies of this type has been done with this drug and its use with treatment of Covid -19 patients. Currently, there are many such studies in progress.
Furthermore the risks of using the drug can be considerable. The side effects include serious eye problems, effects on the heart’s rhythm, seizures , fainting, abdominal pain, hallucinations, and trouble breathing. Just because ‘ it’s been around awhile” doesn’t mean the drug will not harm you. You may have a lot to lose.
More importantly, at this time, we have no idea if it works or not.
We create false hope.
Do no harm.
It is important to remember that no responsible medical or media source is claiming the drug is a cure for the Covid infection.
I can’t speak to the ethics of whether to give the drug to a critically ill patient as a “Hail Mary Pass” to prevent death is appropriate. I have been in life threatening situations where I have faced similar dilemmas. I am sure in hospitals all over the country, conversations about its use in that setting are happening. Families understandably want to do everything possible to prevent the death of a loved one. Such a conversation is best left to the individual doctor and patient. It’s not easy. You need information that is reliable, not a shot if the dark.
Reliability is the point of all of this argument. Where are you getting your information? How can you be informed and make a good decision?
Julia Carrie Wong writes, “The drug’s rapid rise is a distinctly modern tale of misinformation within a global information ecosystem beset by widespread uncertainty, fear, media fragmentation, and hyper-partisanship.” Citing a tiny, flawed study in France, the right has touted hydroxychloroquine as a silver bullet. Fox News has claimed that it has a “100 percent cure rate,” even though four of the 42 people treated with the drug in France died.”
Alex Shephard goes on to say, “The right also has a grudge against the scientific experts in academia and government, who are depicted as being part of a liberal ploy. Anything pushed by experts like Fauci must be cover for some sinister progressive effort to remake society. “
When I got accepted to medical school I was so excited I ran to my University’s medical school bookstore. There I found “Harrison’s Principles of Internal Medicine”. This was a huge reference that many regard as the gold standard for the field. It was 1984 and I purchased it impulsively, carried it home and placed it on my shelf like a trophy. I had no idea what was in it and it would be years before I would actually need it.
Notice the cover below and one of the distinguished authors.
Dr Fauci, and others like him , are NOT saying we shouldn’t possibly use hydoroxychoroquine. He is simply saying let’s see what the evidence shows before we stand at a podium and recommend the therapy to millions of scared people. It is not a conspiracy or a liberal plot. It is just good medicine.
Do no harm.
We need to trust the experts to help guide our decisions. If we don’t, someone will get hurt or valuable time and resources will be spent on unproven therapies.
As hard as it is right now, we have to wait to see if Hydoroxychorquine actually works. In the end, studies may show a benefit and when that happens, we should use the medication. However, to promote it breathlessly now is magical thinking. It is important that we trust the information we are getting so we can make informed choices. After this Hydroxychoroquine scandal subsides, and it will, there will be others in the future. These coming issues will also need to be faced honestly and critical thinking.
Just today in the news Jake Johnson reports, “- During a Coronavirus Task Force briefing Wednesday evening, Trump said "you should add zinc" to any COVID-19 treatment regiment, suggesting that medical professionals have recommended the mineral supplement.
"I want to throw that out there because that's where they seem to be having the best result," said Trump, who has faced criticism for recklessly touting unproven coronavirus treatments. "So you add the zinc and the azithromycin, and it's been—we've had a lot of good stories.”
There is no proof this statement is true. We will see more stories like this one to come.
Like most politicians, Trump is a man who is ultimately interested in his own welfare. Such selfishness in politicians is not unique to Donald, although he has taken self absorption to a cosmic level.
Of course Trump wants a “cure” and soon. Who can blame him? This is an impossible situation with few options. But, pushing unproven theories from the podium of the President of the United Sates is the height of irresponsibility. Words matter. You affect millions of people’s lives.
Waiting for the curve to flatten is causing enormous harm to the economy and people’s lives. People are tired, afraid and angry. They want their lives back. Into this desperation will come hucksters who will prey on the fears of people. It will take thoughtful, calm, and principled leadership to lead us through this valley. If you are honest, can you really say that is happening at the Federal level?
Where are you getting your information?
I think a simple test would be the following. If you were sick and in need of advice and treatment, would you want your trained physician to come into the room or Sean Hannity?
To whom would you trust your treatment? It’s your choice.
It’s your life.
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