Search Results for: hydroxychloroquine

The Hydroxychloroquine Saga

by Rick Bradford

Has much of the world failed to benefit from an effective, early-stage treatment for COVID-19, because early trial results were misleading? There may be a number of drugs we could ask this question of; here I look at hydroxychloroquine.

The Early Indications

Hydroxychloroquine is not an exotic new drug with which doctors and medical authorities have little experience. On the contrary, it has been used widely for decades to treat malaria, lupus and rheumatoid arthritis. It came to public attention as a potential treatment for COVID-19 early in 2020, not least because of President Trump’s espousal of it.

In the period March – July 2020, attention focused on the WHO-led multinational Solidarity Trial and the UK’s own Recovery Trial which addressed the efficacy of hydroxychloroquine against COVID-19.

The Chief Investigators of the Recovery project released a press statement on June 5th 2020 which stated simply, “no clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19”.

On July 4th 2020 the Solidarity project discontinued the hydroxychloroquine and lopinavir/ritonavir trials. The interim trial results showed that hydroxychloroquine and lopinavir/ritonavir produced little or no reduction in the mortality of hospitalized COVID-19 patients when compared to standard of care. The Solidarity Trial found that all four treatments evaluated (remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalised patients.

The Recovery and Solidarity trials were exclusively carried out on seriously ill patients in hospital, rather than the early-stage patients for which there was existing evidence that hydroxychloroquine might be effective. A drug which acts against the pathogen is most relevant when the pathogen is multiplying. In the later stages of COVID-19, the illness becomes an immune-system-driven inflammatory condition, and by that time the original pathogen has already done its damage. Could it be that the negative results of the Recovery and Solidarity trials were due to their deployment to patients in an inappropriate phase of the disease? Certainly, Professor Didier Raoult from IHU-Marseille, and an early leading proponent of hydroxychloroquine, was not impressed with the Recovery trial, accusing it of being “the Marx Brothers doing science”.

In passing I note that a further multinational trial, REMAP-CAP, was also deployed only to seriously ill patients with severe pneumonia admitted to an intensive care unit (ICU). I have found no results from this study. On June 3rd 2020 it was suspended following the scare from a now infamous Lancet paper by Mehra et al which claimed the use of hydroxychloroquine increased death rates (the paper was retracted a few days later). I presume that trial was never restarted.

Another criticism of the Recovery and Solidarity trials which has been made is of the dosage regime, with the doses appearing to be substantially greater than standard practice when the drug is used against malaria, lupus or rheumatoid arthritis (see, for example, “Killing the cure: The strange war against hydroxychloroquine“).

Recent Evidence that Hydroxychloroquine is Effective Against COVID-19

Care is needed here. To recommend a particular drug to medical practitioners requires a randomized controlled trial (RCT). However, before one goes to the expense and trouble of carrying out a controlled trial there must be some prima facie evidence to suggest a positive outcome is likely. Is there such prima facie evidence that hydroxychloroquine is effective when used in the right dosage on patients in the right stage of the disease?

Yes, there is. Lots of it. In fact, far more than is necessary to establish a prima facie case. It is this fact, against indications from the earlier trials, that motivated the writing of this short article. The number of studies emerging which examine the efficacy of hydroxychloroquine, sometimes in combination with other drugs, is substantial – far too many papers for me to review here. Fortunately, review articles are now appearing which bring the big picture together, although what is still needed is a definitive, rigorous meta-analysis published in a top journal.

What I shall do first is give the reader a brief impression of what data is around by looking at a small sample of studies. These alone are sufficient to provide a solid prima facie case. You will see that the evidence comes from all over the world. The weight of evidence that hydroxychloroquine, possibly combined with other drugs, is efficacious in the early stages of COVID-19 is very strong. I will give a status summary of all the studies available as of February 2021 after looking at a few individual studies.

Didier Raoult and the Marseille Team

Although invariably associated in the press with the name of the flamboyant Didier Raoult alone, the paper which was submitted to the journal Travel Medicine and Infectious Disease on May 27th and published online on June 25th 2020 included the names of 43 authors: “Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis“. Extracts from the abstract are:

In our institute in Marseille, France, we initiated early and massive screening for coronavirus disease 2019 (COVID-19). Hospitalization and early treatment with hydroxychloroquine and azithromycin (HCQ-AZ) was proposed for the positive cases. We retrospectively report the clinical management of 3,737 screened patients, including 3,119 (83.5%) treated with HCQ-AZ (200 mg of oral HCQ, three times daily for 10 days and 500 mg of oral AZ on day one followed by 250 mg daily for the next four days, respectively) for at least three days and 618 (16.5%) patients treated with other regimen (“others”).

The patients’ mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%… Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11–0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27–0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17–1.42)… Although this is a retrospective analysis, results suggest that early diagnosis, early isolation and early treatment of COVID-19 patients, with at least three days of HCQ-AZ lead to a significantly better clinical outcome and a faster viral load reduction than other treatments.

Although many patients were relatively young in Covid terms, 12.3% were over 64 (5.7% older than 74). Of patients given hydroxychloroquine, 359 were over 64; of patients given other treatments, 157 were over 64. There was a high level of comorbidity: cancers 4%, diabetes 8%, chronic heart disease 6%, hypertension 15%, chronic respiratory disease 9% and obesity 11%.

The vultures have been circling Raoult for some time. The New York Times did a hit piece on Raoult in which “Trump” occurred 11 times. The Guardian was delighted to give Raoult some publicity… when the story was that he was to be subject of a disciplinary hearing by his professional medical body. In the Guardian story, “Trump” appeared in the third sentence. Muddying the waters of a purely medical question with political partisanship is worrying. There were 42 other authors responsible for the paper as well as Raoult, but Trump was not one of them.

Bernaola (Madrid)

The paper “Observational Study of the Efficiency of Treatments in Patients Hospitalized with Covid-19 in Madrid” by Nikolas Bernaola et al was submitted to the medRxiv medical preprint archive in July 2020 (current peer review status unknown). It concluded: “In this multicenter study of patients admitted with COVID-19, hydroxychloroquine and prednisone administration was found to be associated with improved outcomes. Other treatments were associated with no effect or worse outcomes.” However, it sounds a warning note: “Randomized, controlled trials of these medications in patients with COVID-19 are needed to avoid heavy administration of treatments with no strong evidence to support them.”

Tarek Sulaiman’s Team, Riyadh, Saudi Arabia

The Effect of Early Hydroxychloroquine-based Therapy in COVID-19 Patients in Ambulatory Care Settings: A Nationwide Prospective Cohort Study” was placed on the medRxiv preprint archive on September 13th 2020 with the names of 22 authors. From the abstract:

This observational prospective cohort study took place in 238 ambulatory fever clinics in Saudi Arabia, which followed the Ministry of Health (MOH) COVID-19 treatment guideline. This guideline included multiple treatment options for COVID-19 based on the best available evidence at the time, among which was Hydroxychloroquine (HCQ). Patients with confirmed COVD-19 (by reverse transcriptase polymerase chain reaction (PCR) test) who presented to these clinics with mild to moderate symptoms during the period from June 5th–16th 2020 were included in this study. Our study looked at those who received HCQ-based therapy along with supportive care (SC) and compared them to patients who received SC alone.

All patients were presenting with active complaints; however, the HCQ groups had higher rates of symptoms compared to the SC group (fever: 84% vs 66.3, headache: 49.8 vs 37.4, cough: 44.5 vs 35.6, respectively). Early HCQ-based therapy was associated with a lower hospital admission within 28-days compared to SC alone (9.4% compared to 16.6%, RRR 43%, p-value <0.001). The composite outcome of ICU admission and/or mortality at 28-days was also lower in the HCQ group compared to the SC (1.2% compared to 2.6%, RRR 54%, p-value 0.001). Adjusting for age, gender, and major comorbid conditions, a multivariate logistic regression model showed a decrease in the odds of hospitalisation in patients who received HCQ compared to SC alone (adjusted OR 0.57 [95% CI 0.47-0.69], p-value <0.001). The composite outcome of ICU admission and/or mortality was also lower for the HCQ group compared to the SC group controlling for potential confounders (adjusted OR 0.55 [95% CI 0.34-0.91], p-value 0.019).

CONCLUSION Early intervention with HCQ-based therapy in patients with mild to moderate symptoms at presentation is associated with lower adverse clinical outcomes among COVID-19 patients, including hospital admissions, ICU admission, and/or death.

Derwand, Scholz and Zelenko (USA Data)

The December 2020 edition of the International Journal of Antimicrobial Agents contains the peer reviewed paper “COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study“. The abstract reads:

The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3–6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40–67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06–0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03–1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.

Brazil

Published online in October 2020 in Travel Medicine and Infectious Disease, the peer reviewed paper “Risk of hospitalization for Covid-19 outpatients treated with various drug regimens in Brazil: Comparative analysis” carried the names of nine Brazilian authors and one from the USA. From the Abstract:

Use of hydroxychloroquine (HCQ), prednisone or both significantly reduced hospitalization risk by 50–60%. Ivermectin, azithromycin and oseltamivir did not substantially reduce risk further….This work adds to the growing literature of studies that have found substantial benefit for use of HCQ combined with other agents in the early outpatient treatment of COVID-19, and adds the possibility of steroid use to enhance treatment efficacy.

Switzerland’s Natural Experiment

A rather stunning piece of evidence for hydroxychloroquine’s effectiveness comes from Switzerland, as explained in this article: “Covid-19: l’hydroxychloroquine marche, une preuve solide?” My French is not good, but I get “une preuve solide” right enough. Some background is required first.

On May 22nd 2020, the Lancet published a paper which has become scandalous. It claimed that hydroxychloroquine or chloroquine when used for treatment of COVID-19 decreased in-hospital survival rates. It met with a maelstrom of criticism, and was retracted by the Lancet just 13 days later on June 4th 2020. This is a most unusual occurrence. The newspaper FranceSoir described it using the term “fraudulent study” (l’étude frauduleuse). It has been claimed that its database did not actually exist.

But in the 13 days before the paper was withdrawn it did its damage: the WHO and many Nation States decided to ban the prescribing of hydroxychloroquine due to the scare caused by that paper. (The REMAP-CAP trial of hydroxychloroquine was terminated due to it.) Switzerland, in which hydroxychloroquine had previously been in widespread use, was one of the countries which introduced a ban – on May 27th. But, after the Lancet paper had been withdrawn, the Swiss rescinded the ban and the widespread prescribing of hydroxychloroquine restarted after 15 days on June 11th. This created a natural experiment of the efficacy of hydroxychloroquine. The result is shown by Figure 1 below.

Figure 1

The graph shows, in effect, the mortality rate of COVID-19 patients against date. To be precise, the ordinate is the nrCFR (New Resolved Case Fatality Rate), which is defined as the proportion of deaths among the resolved cases (dead or cured) in the seven days preceding the date in question.

The two vertical lines indicate the cessation of prescribing hydroxychloroquine (May 27th) and its reintroduction 15 days later (June 11th). Prior to May 27th, hydroxychloroquine was in widespread use and the death rate was reducing. A time delay between treatment change and any influence on death rate is to be expected. Thirteen days after the ban on hydroxychloroquine, the death rate leapt upwards to a level not seen since March. Thirteen days after the reintroduction of hydroxychloroquine, the death rate dropped equally precipitously back down to its previous low level. Une preuve solide, it would seem.

Stunning though that is, there is evidence that is perhaps even more stunning.

Covid Analysis Group

I had it in mind to look at how the overall death rates varied between countries according to their usage of hydroxychloroquine. But it’s been done already. A group of researchers calling themselves Covid Analysis Group have been publishing regular updates of exactly that data, the latest being November 14th 2020: “Early treatment with hydroxychloroquine: a country-based analysis.” The key result is shown in Figure 2. The analysis is very detailed. Figure 2 includes adjustments described in the web link, which also gives the raw data. I have not attempted to critique the data.

Figure 2 shows in green the death rate per million for countries with widespread early usage of hydroxychloroquine. The red lines relate to countries with limited early usage of hydroxychloroquine. The graph is so striking it needs no additional commentary. Virtually all the green countries lie at lower death rates than virtually all the red countries. Note the stipulation regarding the deployment of hydroxychloroquine in the early stages of the disease.

Figure 2

The most obvious concern is whether the countries plotted have been cherry-picked, since only a small sub-set of the world’s nations are included. The Covid Analysis Group addressed this issue:

Why is country x not included? Our goal is to identify countries that have taken a strong decision on treatment. Countries without clear decisions are much harder to analyze – to create any meaningful results we need to know the proportion of usage to some reasonable degree… Countries like Italy or Brazil have extremely mixed usage, with differences during major time periods of their outbreak and/or major geographic differences. Analyzing these countries would be much more complex.

The Totality of Available Studies at 26th February 2021

As of February 26th there were 259 studies, 211 which compare with control groups, and 187 peer reviewed. You can find them all listed on this very useful link. I quote that site’s summary of the totality of evidence:

Hydroxychloroquine is not effective when used very late with high dosages over a long period (Recovery/Solidarity), effectiveness improves with earlier usage and improved dosing. Early treatment consistently shows positive effects. Negative evaluations typically ignore treatment time, often focusing on a subset of late stage studies.

Figures 3, 4 and 5 below are lifted straight from that source. Figure 3 shows that all 27 studies which involved treatment during the early stage of the disease were efficacious, the average improvement being 65%. Figure 4 shows all the trials, on both early and late stage patients. Most show a beneficial effect, but a substantial number of late-stage studies produce a worse outcome than controls. Early stage treatment is therefore key, as has been consistently maintained by proponents of hydroxychloroquine in the medical community.

Figure 5 shows the distribution around the world of usage of hydroxychloroquine to treat COVID-19. Limited use is found across all anglophone countries.

Figure 3
Figure 4
Figure 5

Has the Efficacy of Hydroxychloroquine been Misrepresented?

So, has much of the world failed to benefit from an effective, early-stage treatment for COVID-19 because early trials of hydroxychloroquine were misleading? Based on the evidence now accumulating it would appear so. But one of the surprises, to this author, is that the negative view of the efficacy of hydroxychloroquine is highly country-specific, being universal across anglophone countries, whilst most other countries have continued to deploy it. The reader may speculate about the reasons for this.

Rick Bradford is an Honorary Senior Research Fellow in the Department of Engineering at the University of Bristol.

Covid in Australia – a Doctor’s Perspective

There follows a guest post by a doctor in Australia, who prefers to remain anonymous, about his experience of the pandemic Down Under.

I entered General Practice 34 years ago in rural New South Wales. Needless to say, the changes since then have been immense.

In 1988, most GP’s admitted and cared for patients in hospitals, did regular house calls, delivered babies, performed surgery and practiced anaesthetics. Now, other than in remote rural locations, very few provide any of these services. As many patients inform me, most GPs seem to want to only look at their computers, order tests, prescribe drugs, give immunisations and refer to the specialists.

Twenty years ago, I underwent specialist training in Sports and Exercise Medicine, and now work purely in that area. I remain, however, registered as a General Practitioner. The Australian health system has plenty of similarities with the British system, though has a number of features which differentiate the two. In Australia, the vast majority of GPs work in the private system, working as contractors to health centres, being employed by private practices, running practices themselves, or in a dwindling number of cases working as solo GPs. Very few work as employees of the public sector or NGOs.

Each state has a Health Department, which can impose different regulations on GPs, such as Covid vaccination requirements, and runs the public hospitals in that state; the Federal Government also has a Health Department which oversees the registration of doctors, pharmaceutical benefits scheme and health budgets. Registration is governed by the Australian Health Professional Regulation Agency (AHPRA) via the Medical Boards. The Therapeutic Goods Administration (TGA) controls drug and device availability. There are both Federal and State Chief Medical Officers (CMOs) dictating policy settings. The Australian Medical Association (AMA) is a lobby group representing less than 15% of doctors, but has political sway. Continuing education and training is provided by the Colleges – in the case of General Practice, this is both the Royal Australian College of General Practice (RACGP) and Australian College of Rural and Remote Medicine (ACCRM).

Early on after the advent of the Covid vaccination program, the TGA banned prescription of hydroxychloroquine and ivermectin for Covid infections, partly as they were seen as possible threats to vaccine uptake. Recently, the prescription of hydroxychloroquine for Covid infections again became legal, though only in Queensland.

Postcard From Romania – Part II

We’re publishing a “Postcard From Romania” today, the second from a man calling himself Niculina Florea (a pseudonym). The picture above is of a Christmas tree made out of empty vaccine bottles, an attempt to persuade Romanian children to get vaccinated. For Romanians, being bombarded with hysterical state propaganda telling them to expect all sorts of privations in response to a mortal threat is nothing new. They experienced that often during the 42-year Communist dictatorship that ended with the fall of Ceaușescu in 1989 and have learnt to treat all such official campaigns with a large dose of salt. Here is an extract.

Romanian life goes on unabated for the most part. A long history of occupation and barbarian invasion, combined with the ruling class’ regular betrayal of the less privileged, caused the evolutionary gears to shift long ago. Opportunism and tactical cunning have been bred into the population. Romanians do not stand up, they bend; and they bend backwards not forwards, securely rooted so that they may face the prevailing wind without being torn asunder.

They are not opposed to vaccination; they just don’t get vaccinated. Your employer has demanded a covid certificate (though not yet a legal requirement)? Here is a fake one for your pleasure, sir! The authorities order positive cases to report for quarantine if symptomatic? Why doctor, I haven’t got so much as a cough! (just remember to clear your throat when the health authorities pay a visit.)

Meanwhile, the market for ivermectin, hydroxychloroquine and a strong antiviral, arbidol, is flourishing. You’ll find these banned products in your local pharmacy, if you know how to ask. The regime beams daily TV reminders to the population of what fools they were – the dead – for treating themselves with outlawed medicines. The dead are, almost without exception, those who ignored the advice (i.e., diktats) of the state.

Worth reading in full.

Postcard From Romania – Part II

by Niculina Florea

Christmas tree made of empty vaccine bottles to encourage Romanian children to get vaccinated.

Mihai Fagadaru is dead.

Of course, nobody knows who Mihai Fagadaru was.

Fagadaru was a medical doctor, father of two, fervent Christian and leader of protests against Covid measures in my home country of Romania. On October 30th he led a protest in our capital of Bucharest. The following week, after treating two patients sick with Covid, he himself fell ill. He went to hospital on November 18th, where his condition suddenly deteriorated. In his final hours he recorded himself saying that doctors were putting him under pressure to accept intubation. He was afraid the procedure would kill him. He asked that his lawyer record his refusal to give consent and that his friends care for his children should his fears be realised.

Dr. Fagadaru had arrived at that hospital on his own two feet. The next day he was declared dead with Covid at the age of 43.

The national press hastened to declare, in large type, the death of an infamous anti-vaxxer from the very disease he had denied and would not be vaccinated against. Perhaps, during his last moments on earth, he expressed regret at not taking the vaccine? But with the Fagadaru’s own video contradicting a deathbed conversion, the media mob moved onto the next of the day’s hundred or so Covid fatalities (most of them, according to official statistics, unvaccinated): the search for dying lips, to which some click-baiting last words might be attributed, must go on.

This is what passes for news in Romania these days; a country on the brink of civil strife and wracked with governmental instability; which is already onto its third Prime Minister this year and enjoyed a turnout of 30% in January’s general elections; and where there have been protests against Covid measures every week since spring. Meanwhile, despite a rapidly receding fifth wave, a gentile debate continues in a parliament of questionable legitimacy about whether to legislate for a covid vaccination certificate.

When this wave was at its peak the eyes of Europe, or at least its mainstream media bloodhounds, were upon us. They were looking for a horrific situation in “one of the most unvaccinated countries in Europe”. Curiously, now that wave has receded, so too have the hacks, and any commentary on our collective vaccination status or lack thereof has dried up.

It remains, however, a convenient angle for the national Government, dovetailing as it does with the trusty blame-it-on-Russia approach to problem-solving. Thus, these days, all evil is born of a combination of the unvaccinated and ‘Russian disinformation’. That Russia, much like the West, has introduced draconian restrictions and is preparing for compulsory vaccination is neither here nor there. Of equal irrelevance is that the Russian vaccine cannot be sold in the EU as it does not have EMA approval. So, when hearing complaints that it is Russia who is trying to destabilise western democracies, am I alone in perceiving a possible nonsense?

Romanians live in many shadows. Russia is one, our recent experience of dictatorship another. Echos of that past can be heard with increasing clarity. Do you know, for instance, that PCR in Romanian stands for ‘Partidul Comunist Roman’? The CC-PCR, or Central Committee of the Romanian Communist Party, was the tool of control in Romanian society for decades. Today it is the RT-PCR. Can it be no more than coincidence that the health authorities have made this the only accepted test for administrative purposes? Certainly, that Romanians are viscerally repelled by the abbreviation is of little concern.

Here is another striking reminder of the old days: the resurgence of dichotomies. ‘Whoever is not with us is against us’ was once a popular Communist saying. How odd to hear that old tyranny on the lips of today’s democratic leaders! For, as we all know, he who is not pro-vaxx is an anti-vaxxer. And, by the same easy-to-follow logic, he who is not in favour of restrictions is an anarchist; while he who does not espouse hard-left ideas is a right-wing extremist; and he who questions government measures is a terrorist.

Despite these regresses, Romanian life goes on unabated for the most part. A long history of occupation and barbarian invasion, combined with the ruling class’ regular betrayal of the less privileged, caused the evolutionary gears to shift long ago. Opportunism and tactical cunning have been bred into the population. Romanians do not stand up, they bend; and they bend backwards not forwards, securely rooted so that they may face the prevailing wind without being torn asunder.

They are not opposed to vaccination; they just don’t get vaccinated. Your employer has demanded a covid certificate (though not yet a legal requirement)? Here is a fake one for your pleasure, sir! The authorities order positive cases to report for quarantine if symptomatic? Why doctor, I haven’t got so much as a cough! (just remember to clear your throat when the health authorities pay a visit.)

Meanwhile, the market for ivermectin, hydroxychloroquine and a strong antiviral, arbidol, is flourishing. You’ll find these banned products in your local pharmacy, if you know how to ask. The regime beams daily TV reminders to the population of what fools they were – the dead – for treating themselves with outlawed medicines. The dead are, almost without exception, those who ignored the advice (i.e., diktats) of the state.

“Don’t follow the example of young, healthy upstarts like Fagadaru,” the state-sponsored news channels chide, “or you too will be languishing on your deathbed, whispering your regret at not being vaccinated.” Well, if they think we’re going to just take them at their word, they must think we peasants have short memories! Our blood-soaked revolution took place a little over 30 years ago. That’s not even a lifetime. Certainly I remember, as anyone my age can, never mind a member of my parents’ generation, what life is like under tyranny.

I remember the rationing of basic foods, not for the population’s oppression or to maintain a primal state of destitution and fear, you understand! But to ensure “nutrition according to science” and that the earth would not be deprived of her riches.

I remember two hours of energy cuts a day at peak hours, radiators left cold in the middle of winter to conserve fossil fuels, my fingers frozen crooked as I did homework by candlelight, kneeling on the floor and covering myself with three blankets in an attempt to keep the cold away.

I remember conversations conducted sotto voce so that the neighbours, encouraged by state propaganda, would not eavesdrop and turn you in.

I remember the long, pointless meetings, the ritual self-abasement at those meetings as a demonstration of humility, and the unconditional applause for Communist Party leaders.

I remember the lack of free speech, the lack of free thinking, the pervasive censorship – of books, of philosophical ideas, of the press – more applause…

I remember the personality cult, the same face on TV and banners and buildings, the same face everywhere, in a country where advertising (a decadent bourgeois habit) was forbidden; flamboyant speeches on the creation of “the New Man”, on the dawning of the “Golden Era” – applause!; of the “multilaterally developed society” – applause!; being told the “One Truth” policy, and “don’t listen to capitalist propaganda, don’t switch on to Free Europe radio, don’t be an enemy of the people, the neighbours are listening” – applause!; hearing that “people are starving in the West, it’s full of drug addicts and marred by unemployment, don’t go there, don’t ever believe what you hear, it’s propaganda…” – applause, applause, applause!

How could anyone forget? Yet here we are again: Stay home. Don’t be selfish. Save the health service. Save Granny. Applause. What if Granny does not want to be saved? Irrelevant. The state says she must be saved. So she must be jabbed. Now she’s jabbed. Applause. Jab her again. Protect the state. Follow the Science. Don’t listen to disinformation. Cancel anti-vaxxers. Applause. Report infractions. It’s the dawning of the New Normal. Applause. Wash your hands. Wear a mask. Keep your distance. Get tested. You’re dirty. Don’t kill Granny. Applause. Listen to this speech. Don’t leave. Don’t go there. It’s dangerous. It’s on the red list. Applause. Quarantine outsiders. Imprison anti-vaxxers. Follow the One Science. It’s the software of life.

And the same faces. The same masked faces everywhere saying: Be afraid. Be afraid and get jabbed. And get jabbed again. Get jabbed again and again and again. But the jabs don’t seem to work…

This popular fraud comes as no surprise. In my society we have been playing this game of cat and mouse for centuries. They seek to enslave us, we seek to cheat them on that. They know the wickedness of the common people, the authorities; they know of their deceit and mischief. So why wait for Parliament to act? Why not arrange for local businesses and public bodies to enforce covid certification while sluggish parliamentarians make their law? That is why people in my hometown cannot access municipal services, or even pay their taxes without presenting an unlawful certificate. And where is the humanity of our superiors, I wonder? Reserved, perhaps, for “overworked” medics, who cry of exhaustion on TV shows and foam with rage against the unjabbed preventing them from taking their holidays.

My views can be inconvenient. “Stop reading obscure sites!” says my best friend from Bucharest, with whom I have shared the best, worst, most intimate, and most secret moments of my life. For the past two years she has incessantly posted photos of dogs, cats, birds, wildlife and attractive colleagues on Facebook; projecting an image of a perfect world. Now I’m a conspiracy theorist, un-jabbed and unapologetic, she doesn’t want to talk to me. “Where is your compassion, my old friend?” she asked.
Perhaps I have none left. I have expended it on passage for ones dear to me, to bring them out of the darkness and back to the light. What a price I pay! Communism was easy. It was so fearlessly disingenuous and so horrifically vulgar as to be obvious. It never touched the spirit. People obeyed out of fear, not belief. In body we may have been dirty and destitute, but in soul we were pristine. This time it’s different. It’s insidious. ‘It’ has crept into the hearts and minds of people. ‘It’ has separated friends and families. ‘It’ has torn through the fabric of society. And when torn, the insides come bursting out.

Recently, some monks came down from monasteries nestled in the mountains to the north. They made their way to Bucharest and addressed a large crowd. Doughty Father Ariton made it, but Father John, over 90 winters, could not manage the journey. He sits in his hermitage, receiving pilgrims in their dozens every day, stubbornly refusing to contract and die from ‘the disease’. The authorities would love that, surely! They could parade his body from town to town, exhibiting their war trophy: there, you idiots, we told you so!

Can anything stop the slide into tyranny? Three weeks ago Parliament failed at the first attempt to pass the Covid Certificate Act. Two weeks ago, the December 1st kick-off for the programme to vaccinate five year-olds (an early present from Santa) was delayed awaiting deliveries of the product. But these are mere obstacles, effortlessly overcome by the spreading darkness.

As I watch its approach, I feel angry with our cowardly leaders. I think of brave citizens like Dr Fagadaru and weep. They are simple people who would hold back the darkness, and whose reputations are sullied posthumously for no more than disagreeing with the revival of a terrible status quo. I am too angry to forgive the political class, the medics, the media. But neither do I wish to see the light die with men like Fagadaru. Perhaps I can draw inspiration from my fellow Romanians. As ever, they hold their ground. Bent, not upright. That’s how you fight an ill wind.

The Mail Asks Serious Questions About Fraudulent Research

A few days ago journalist Barney Calman published a thorough and well researched article about the problem of academic research fraud. Although the contents will seem familiar to any long time reader of the Daily Sceptic, it’s great news that much bigger audiences are now being exposed to information about the scale and nature of the problems inside scientific institutions.

In July the Daily Sceptic published an article by me entitled, “Photoshopping, fraud and circular logic in research“. It discussed the problem of Asian paper forging operations colloquially nicknamed “paper mills”, the Chinese Government policies that incentivise forging of scientific research, and cited former BMJ editor Richard Smith’s essay on the problem of fictional clinical trials. For classical journalists to write about a topic typically requires them to find an insider or specialist willing to put their own name on things – indeed, one of the major weaknesses of newspapers vs blog sites like this one is their reluctance to do original research into scientific topics. Scientists willing to put their names on allegations is the permission journalists need to cover a story like this – and now the Mail has it:

Speaking on the Mail on Sunday’s Medical Minefield podcast, Smith – who was involved in the investigations that exposed Malcolm Pearce – said:

“It’s shocking, but common. Many of these fraudulent studies are simply invented. There were no patients. The trial never happened.”

Research coming out of countries where doctors are commonly rewarded with pay rises for publishing their work – such as Egypt, Iran, India and China – is more likely to be faked, investigations show. 

“In China, doctors can only get promoted if they score enough ‘points’, by getting published,” says John Carlisle, an NHS anaesthetist who spends his spare time hunting for fraudulent medical studies.

Calman cites many examples of serious research fraud:

  • Malcolm Pearce, who created a non-existent pregnant women he claimed to have saved from an ectopic pregnancy and who forged a drug trial.
  • Werner Bezwoda, who falsely claimed he had cured women with breast cancer by giving them bone marrow transplants.
  • Eric Poehlman, the only one ever jailed for research fraud, who fabricated studies into weight gain and the menopause.
  • Woo Suk Hwang, who became a national hero in South Korea after claiming a breakthrough in stem cell research that never actually happened.
  • Joachim Boldt, who forged a staggering 90 studies into drugs for regulating blood pressure during surgery. “These trials had been published over many years in leading journals, but it turned out they had never happened,” says Ian Roberts, Professor of Epidemiology at the London School of Hygiene and Tropical Medicine. “Again, when they were excluded from the review, it showed the treatment was not effective. British surgical guidelines had to be changed. It made me realise, if someone can get away with fabricating 90 studies, the system isn’t working.”

The story also discusses how the scientific system has been unable to reach agreement on the effectiveness against COVID-19 for both hydroxychloroquine and ivermectin, largely due to how high profile trials showing efficacy keep turning out to be fraudulent.

There’s much more and the entire article is, of course, worth reading in full.

Analysis

Smith zeros in on the core problem: the scientific system is entirely trust based. If someone emails a Word document containing a table of results to a journal, then it’s just assumed that the trial did in fact take place as written. The document itself is supposed to be reviewed, although as we’ve previously discussed here peer review is sometimes claimed to have happened when it very obviously couldn’t have. But nobody checks anything deeply. Peer reviews, when they properly happen, take the intellectual honesty of the submitter for granted.

This system was probably okay at the start of the 20th century when science was a small affair dominated by hobbyists, companies and standalone inventors. It’s easy to forget that Einstein, perhaps the most celebrated scientist of all time, came to the attention of the world only after developing new physics in his spare time whilst working as a Swiss patent clerk. But after the end of World War Two governments drastically ramped up their spending on academic research. Throughout the 20th century science didn’t just grow, it grew exponentially (nb. log scale):

Source: Lutz & Bornmann, 2014

In the second half of the 20th century, the number of papers published annually was doubling about every nine years, with the end of the war being a clear inflection point.

A century ago there was very little incentive for a scientist to lie to a journal. There was no point because there wasn’t much money in it. Academic positions were rare, the communities were small, and there were few enough interesting claims being published that they’d attract attention and be discovered if they weren’t true. But in 2021 it’s all very different. Annual production of new scientists by academia alone is vast:

The benefit of using the PhD as the yardstick for number of scientists is that it has a more standard definition across countries than measures such as the number of professional researchers and engineers.

The effect Chinese policies have had on science can be clearly seen in this graph, but even before China more than doubled its PhD production the trend was strongly upwards.

Underlying this system is an implicit assumption that the number of discoveries waiting to be made within a given time window is unlimited. Giving scientists money is seen as an uncontroversial vote winning position, so nobody in government stops to ask whether there are actually enough answerable scientific questions available to absorb the increased research budgets. If there aren’t then people become tempted to either make up answers, as in much of the COVID ‘science’ that is written about on this site, or make up questions, hence the proliferation of un-rigorous fields like the study of “white tears“.

Did Barney Calman get wind of this story by reading this site? It’d be nice to think so. If you’re out there Barney, why not drop us a line and say hello? There are plenty more investigations like that one in the archives of the Daily Sceptic, such as “Fake Science: the misinformation pandemic in scientific journals” and “436 randomly generated papers published by Springer Nature“, which examine the use of AIs to generate fake scientific papers, or “The bots that are not“, which shows that virtually all academic research into the existence of bots on Twitter is wrong. It’s of vital importance that our society becomes more aware of the flaws in the research system, as it’s the only way to break the cycle of governments and media taking so-called scientific claims for granted.

News Round-Up

The BBC versus Donald Trump

The first original essay we’re pubishing on the Daily Sceptic is by Dr Freddie Attenborough, a former lecturer in sociology and a Lockdown Sceptics regular. Freddie’s contributions to the site have been among the very best – he wrote the essay about how Britain responded to the 1957-58 Asian Flu epidemic that you can read here, as well as this angry tribute to those laid low by the lockdowns on 1st January.

His latest essay – which you can also read at his newly-minted substack account – is about the BBC’s double standards when it comes to ‘misinformation’. On the one hand, it publishes ‘fact checks’ that supposedly expose the crackpot conspiracy theories being peddled by ‘Covid deniers’; but on the other it regularly pumps out hysterical, pro-lockdown propaganda that, by any rational measure, is also ‘misinformation’. Here is an extract:

In March 2021, the BBC reported that one of their investigative teams had, “Been tracking the human toll of coronavirus misinformation”. During this investigation they claimed to have found links to “assaults, arsons and deaths”. Worryingly, experts also told them that, “The potential for indirect harm caused by rumours, conspiracy theories and bad health information could be much worse”. Sounds like an interesting investigation, doesn’t it? Public service output at its finest, you might think. Just the kind of article we’d all like to read.

Alas. Not quite.

The problem with the BBC is that it simply can’t help itself. Having teed an ostensibly interesting story up in this open, investigatory journalistic type of way, its authors then proceed to devote a good-ish chunk of what follows to that most favourite of all BBC pastimes, namely, implicating Donald Trump in the act of mass murder. As with the butterfly so beloved of chaos theory (you know the one: that little blighter who’s always flapping his wings and causing tsunamis to crash into the coast of Bangladesh) no sooner have the BBC shown us Trump tweeting about the FDA’s preliminary research into hydroxychloroquine as a prophylactic against Covid than the magic of non-deterministic linear physics kicks in and people all over Nigeria and Vietnam suddenly start mopping up the old bleach-based products like vacuum cleaners.

In the end, then, the only interesting thing about this article is the way it reminds us just how little time and attention the BBC have paid to exploring the link that surely must exist between Covid ‘misinformation’ (as they themselves insist on calling it) and the huge rise in cases of psychosomatic disorder – health anxiety in particular – that we’ve witnessed in the UK since the dawn of the Age of Lockdown (2020-present). Let me explain what I mean.

And to do so, let me start by asking a question: what might disinformation likely to precipitate new, or to heighten existing, levels of anxiety amongst those suffering from psychosomatic disorders look like? How, in other words, might we define such a thing? Well, perhaps we might say that it would be information that unduly exaggerated the risks associated with Covid. Perhaps we might go further and say that it would represent the risks associated with Covid in a highly misleading and/or a sensationalist way. Come to think of it, perhaps we might end up concluding that it would look rather like the BBC’s recent article, “Long COVID funding to unearth new treatments.

Worth reading in full, as is Freddie’s recently published collection of essays about the pandemic Notes From the Blunderground.

The BBC vs Donald Trump

by Freddie Attenborough

In March 2021, the BBC reported that one of their investigative teams had, “Been tracking the human toll of coronavirus misinformation”. During this investigation they claimed to have found links to “assaults, arsons and deaths”. Worryingly, experts also told them that, “The potential for indirect harm caused by rumours, conspiracy theories and bad health information could be much worse”. Sounds like an interesting investigation, doesn’t it? Public service output at its finest, you might think. Just the kind of article we’d all like to read. 

Alas. Not quite. 

The problem with the BBC is that it simply can’t help itself. Having teed an ostensibly interesting story up in this open, investigatory journalistic type of way, its authors then proceed to devote a good-ish chunk of what follows to that most favourite of all BBC pastimes, namely, implicating Donald Trump in the act of mass murder. As with the butterfly so beloved of chaos theory (you know the one: that little blighter who’s always flapping his wings and causing  tsunamis to crash into the coast of Bangladesh) no sooner have the BBC shown us Trump tweeting about the FDA’s preliminary research into hydroxychloroquine as a prophylactic against Covid than the magic of non-deterministic linear physics kicks in and people all over Nigeria and Vietnam suddenly start mopping up the old bleach-based products like vacuum cleaners. 

In the end, then, the only interesting thing about this article is the way it reminds us just how little time and attention the BBC have paid to exploring the link that surely must exist between Covid ‘misinformation’ (as they themselves insist on calling it) and the huge rise in cases of psychosomatic disorder – health anxiety in particular – that we’ve witnessed in the UK since the dawn of the Age of Lockdown (2020-present).  Let me explain what I mean. 

And to do so, let me start by asking a question: what might disinformation likely to precipitate new, or to heighten existing, levels of anxiety amongst those suffering from psychosomatic disorders look like? How, in other words, might we define such a thing? Well, perhaps we might say that it would be information that unduly exaggerated the risks associated with Covid. Perhaps we might go further and say that it would represent the risks associated with Covid in a highly misleading and/or a sensationalist way. Come to think of it, perhaps we might end up concluding that it would look rather like the BBC’s recent article, ‘Long COVID funding to unearth new treatments.’ Below is the thumbnail picture accompanying the piece. 

As you can see, it depicts two masked patients, chaperoned by two masked nurses, who look unmistakably like they’re having to learn how to walk again. (And by the way, anyone who’s going to counter that it could just as plausibly be a depiction of two patients being tested for, say, oxygen carrying capacity or pulse rate during recovery from a respiratory illness like Covid would need to explain to me why it is that neither patient is shown to be wearing any tracking/monitoring equipment, and, in addition, why neither nurse is shown to be holding/studying any data monitors). The male patient in the foreground of the image looks particularly unsteady on his feet, relying heavily on the metal frame surrounding him for bodily support. One of the masked nurses stands next to him, watching his legs and feet intently, presumably scanning for any warning signs of imminent collapse or a stumble. Her right arm is stretching out towards him, and no doubt a guiding/supportive hand is resting on the patient’s shoulder. Just behind the male patient, you can also see the lower half of the wheelchair in which he will have been brought from his hospital ward and into this rehabilitation class. 

But if that’s what it shows, then what kind of patient might actually need rehabilitation of this kind; rehabilitation, that is, in which patients are having to learn how to walk again? It’s the type of thing that you’d imagine is normally reserved for patients needing post-surgery rehabilitation; patients who’ve suffered spinal cord injuries, neurological disorders, car-crashes, amputations and the like. That’s big league, serious stuff. We’re essentially talking about a type of rehabilitative treatment for people who’re on the cusp of, or who’re already suffering from, life-changing injuries/illnesses. 

So is this the type of treatment that people suffering from Long Covid are likely to need?  I ask because as we’ve already established, it’s the type of treatment that’s depicted in the image the BBC have attached to an article entitled, “Long Covid funding to unearth new treatments” the first paragraph of which reads: “Thousands of people with ‘long Covid’ could benefit from the funding of 15 new studies of the condition, its causes and potential treatments”. To help us on the way towards answering this question, here’s what the NHS guide to the symptoms currently associated with ‘Long Covid’ has to say for itself:

Common Long Covid symptoms include:

  • extreme tiredness (fatigue)
  • shortness of breath
  • chest pain or tightness
  • problems with memory and concentration (‘brain fog’)
  • difficulty sleeping (insomnia)
  • heart palpitations
  • dizziness
  • pins and needles
  • joint pain
  • depression and anxiety
  • tinnitus, earaches
  • feeling sick, diarrhoea, stomach aches, loss of appetite
  • a high temperature, cough, headaches, sore throat, changes to sense of smell or taste
  • rashes

Now I’m no doctor, admittedly, but I’m not entirely satisfied that a programme of rehabilitative walking usually reserved for wheelchair bound patients in post-surgery recovery is going to prove particularly efficacious when it comes to the treatment of long Covid patients with earache, diarrhoea and changes of smell or taste. In fact, I’m not satisfied at all.

Indeed it rather seems to me that the BBC’s choice of image, when considered as an accompaniment to this particular article, might justifiably be described as misinformation; that is, as information that unduly exaggerates the risks associated with long Covid in a highly misleading or a sensationalist way. 

By the way, do you like my definition of misinformation? Thanks. Perhaps it might interest you, then, to know it’s culled from the BBC’s own editorial guidelines. Specifically, therein we find “Section 3, Accuracy”, and, more particularly, “Sub-section 3.3.24”, which states that, “Reconstructions [which this image undeniably is] are when events are quite explicitly re-staged”, and that in order to abide by the BBC’s editorial guidelines, “They should normally be based on a substantial and verifiable body of evidence… [and they] should not overdramatise in a misleading or sensationalist way”.

On this basis, then, is it not the case that the BBC’s own reality-check team, that bastion of fairness and impartiality in a world gone wrong, should hold the organisation to account for spreading long Covid misinformation? Is it not an article that exaggerates and sensationalises the effects of long Covid? Further, is it not likely to generate additional, or indeed to heighten existing cases of, psychosomatic health disorders in the U.K.? 

I guess if you’re the type of person who’s already suffering from heightened worry about your health, about lockdown, about physical contact with others, about viruses, about disease; I guess if you surf the web but never really read anything carefully; if you scan the thumbnails on the BBC’s news homepage but never click through to the articles; if you look at an article’s opening image and then only scan the first two or three paragraphs of text thereafter… then I guess, absolutely, it might indeed be considered ‘misinformation.’   

“But isn’t this all just a little pedantic?” I hear you ask. “A bit nit-picky?” Oh, absolutely. And doesn’t it feel good to be playing the BBC at their own game for a change. So good, in fact, that you really must forgive me. I’m enjoying myself so much that I’m going to continue to be pedantic for a little while yet.

Because you see I guess, too, that if you’re prone to experiencing psychosomatic disorders of one kind of another, if you’re already well-known to your local GP surgery and A&E, then it might panic you quite a bit to think that the image the BBC have chosen to use here depicts a fate that might lie in store for you too if you ever contracted Covid and then experienced Long Covid. I guess too that if you’re that way inclined, then you might even feel you needed to take the vaccine, any vaccine, right this minute, no questions asked, jab jab jab, please, put it in me doctor, oh God, put it in me… and to hell with any kind of informed consent. 

Jabbed or not, if you’re that way inclined then I guess you might nevertheless see that picture, that image of the Long Covid patient struggling to walk in the BBC’s article, and then, at some point later, get around to thinking that you’re experiencing the symptoms of Long Covid, that you’re really ill, that you’re dying, that you’re in need of immediate and very urgent medical attention, that you’ve got to go to A&E immediately because you might end up in a wheelchair unable to walk; I guess, too, that you might see that picture and then end up yo-yo-ing in and out of the healthcare system for the rest of your life, costing the taxpayer money, wasting valuable medical time, worrying that there’s a direct line of causality that “the science” has established between you coughing, you sneezing and you ending up in hospital needing a wheelchair to get you to your rehabilitative walking therapy sessions. 

It’s strange, isn’t it? I mean, the BBC is normally so keen, so eager, to castigate others for disseminating what they’ve decreed to be Covid misinformation capable of causing or exacerbating existing physical disorders. Yet in the case of psychosomatic disorders – i.e.  panic, hyperventilating, health anxiety, generalised anxiety, hypertension, depression, chills, gastrointestinal disturbances – they’re curiously reluctant to take up those same sanctimonious ‘fact-checking’ cudgels. 

It’s a reluctance that matters, though, isn’t it? The sad and unfortunate thing about psychosomatic disorders is that those suffering from them are more likely than almost any other group in society to place unnecessary pressure on the NHS. After all, if you’re worried that you’re seriously unwell and/or in imminent danger of dying, where’s the first place you’re going to go? That’s right: a primary or secondary healthcare provider. The problem, of course, is that people who suffer from those types of disorders are neither seriously ill nor in imminent danger of dying. What they ‘are’ is suffering from severe anxiety. That’s not nothing, of course; but it’s hardly first responder or A&E type stuff, is it? 

That this might constitute a problem during a global pandemic of a mild respiratory illness in which we’ve all been told to put our lives, businesses, careers on hold because the NHS is under massive existential pressure, seems obvious. If the NHS is already clogged up with respiratory tract illness and you then go and add a whole bunch of psychosomatic patients to the mix… well, you’ve got a problem, haven’t you? You’d think the BBC would care about that sort of thing, particularly given the pious, reverent tone it normally adopts when it’s representing the NHS. You’d think they’d want to provide balanced, calm, rational reportage of what was going on; reportage that was clear about the extremely low risk Covid poses to the vast majority of people in this country.

I wonder. Could it be that if we were to widen the scope of the concept of ‘misinformation’ to include not only information capable of causing physical harm, but also that likely to cause psychosomatic harm, we’d be forced to conclude that the BBC, with all its Covid exaggerations, its hyperbole, its uncritical, unreflexive treatment of “the science” handed down to it by SAGE, its failure to hold the Government to account, to approach statistics sceptically, to put case numbers into perspective, its obsession with filming death porn reports from inside hospitals (etc etc)… if we were to consider all of that as misinformation too, might we not end up concluding that the BBC has done as much damage to the psychological health and wellbeing of the nation it purports to inform, educate and entertain as Donald Trump ever did with his tweety-tweety chit-chat about preliminary research into hydroxychloroquine as a prophylactic against Covid? I wonder indeed.

Dr Freddie Attenborough is a former academic. You can see his substack account here.

“Open a Window”: How Many Are Dying Because This is Still the Best ‘Treatment’ the NHS Offers to Those Suffering With COVID-19 at Home?

The highly recommended HART bulletin this week has a piece on how the NHS is failing Covid patients by not offering any adequate early treatment, despite the now plentiful evidence of the clinical effectiveness of a number of safe, repurposed drugs.

Nearly a year and a half after the country was locked down to protect the NHS, how is the NHS performing in managing the very condition that so threatened it?

If you suspect that you or a member of your household is suffering from COVID-19 the advice is to get a test and contact NHS 111 for advice. When you do this you are asked a series of questions designed to ascertain how seriously ill you are. If you report “red flag” symptoms such as severe breathlessness or oxygen saturations below 90% quite rightly you are advised to call 999. But what about the less severe cases? The National Institute for Health and Care Excellence (NICE) has issued guidance to clinicians on how to assess and manage patients with COVID-19. Patients not severely ill and requiring hospital admission are managed in the community. The guidance advises symptomatic treatment such as a teaspoon of honey or linctus or even morphine sulphate tablets to suppress coughing. This in itself is bizarre advice, given that the British National Formulary (BNF) only recommends morphine for treatment of cough in palliative care with a ‘reminder of the risk of potentially fatal respiratory depression’.  Paracetamol or ibuprofen is recommended for fever. For breathlessness it advises to keep the room cool and open a window. For agitation and anxiety it even recommends a trial of a benzodiazepine (a tranquiliser medication) despite this potentially leading to respiratory depression.

What does not feature in the guidance is early treatment of COVID-19 in the community. Drug treatments such as dexamethasone and remdesivir are recommended for hospital patients. There are a number of established medicines such as ivermectin, hydroxychloroquine, zinc and famotidine which have been advocated for early treatment. The evidence in favour of ivermectin, in particular, is growing rapidly as this meta-analysis by HART member Professor Norman Fenton and his colleague Professor Martin Neil shows.

Similarly, early administration of inhaled budesonide (an asthma drug) has been shown to reduce the likelihood of needing urgent medical care and reduced time to recovery while a peer-reviewed study in the USA showed fluvoxamine (a common antidepressant drug) prevented clinical deterioration in outpatients with clinical COVID-19.

The U.K. has been quick to roll out COVID-19 vaccines that are still undergoing their clinical trials yet seems reluctant to explore the possibility of cheap treatments with long established safety records. Surely this begs the question why?

Read the bulletin in full here and sign up to receive the next one here.

The BBC’s Dishonest Attack on Ivermectin

The following article by Dr Edmund Fordham and Dr Tess Lawrie was first published by HART and is reproduced here by kind permission.

The July 3rd episode of Tim Harford’s More or Less: Behind the Stats, broadcast on BBC Radio 4 and the World Service, spread more medical disinformation with a piece entitled “Is ivermectin a Covid wonder drug?” Timed to follow publication of an article in Clinical Infectious Diseases by Roman et al on June 28th, this piece seems a clumsy attempt to discredit the landmark British study of Bryant, Lawrie et al which was published by the American Journal of Therapeutics in June and has recently appeared in the current (July) print edition.

Though published by British authors – based at Dr Tess Lawrie’s Evidence-Based Medicine Consultancy Ltd in Bath and the University of Newcastle — and despite these authors lacking any conflicts of interest, BBC Radio 4 made no attempt to contact any of the study authors for interview or ‘right of reply’, which is a fairness obligation under the Ofcom Broadcasting Code. Instead, Harford spoke to one Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong in Australia.

Bryant et al have published the world’s first Cochrane-standards systematic review and meta-analysis of available randomised clinical trials of ivermectin in treatment and prevention of COVID-19. Review of 3,406 patients in 24 randomised trials demonstrated a mortality risk reduction of 62% on ‘moderate certainty’ evidence. The documentation is meticulous and comprehensive. Its restriction was to ‘randomised’ clinical trials because non-randomised studies are typically disregarded by regulatory authorities. There was no ‘cherry picking’: all available trials at the study cut-off date were included.

Meyerowitz-Katz referred to Roman et al, with an almost identical but not the same title, which also claims to be a systematic review and meta-analysis. The study surveys only 1,173 patients over 10 studies, with the remaining known randomised trials arbitrarily excluded. Moreover, the article misreports published clinical trial data in a way that verges on falsification of data, as an Open Letter to the Editor-in-Chief has detailed. The initial misreporting while on the preprint server medRxiv included a farcical reversal of the treatment and control ‘arms’ of the clinical trial of Niaee et al, drawing protest from Dr Niaee himself which can still be found in the comments section of medRxiv. Unfortunately for Clinical Infectious Diseases, further misreporting (undetected by the journal’s peer reviewers) remains, in a way that renders the article worthless. Further background on the sources can be found here.