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Tom Hogan's avatar

*** edited for clarity

OP: "The study design itself was puzzling, a lightly used method called a “Self-Controlled Case Series” which required about 30 minutes of reading and re-reading on my part to even comprehend what they had done."

Dr. Tracy Hoeg had an educational comment about the Florida study.

"Both on Twitter and in the mainstream media, people were quick to try to criticize the study design for inappropriate controls or for lack of information on benefits of the vaccine. But the so-called “self-controlled case series (SCCS)” method has a very smart built-in control group of only people who have experienced the adverse event and is simply not designed to assess benefits.

The SCCS method was actually created to assess vaccine safety. It was first introduced by Paddy Farrington, Elizabeth Miller and team in The Lancet in 1995 as a way to look for association of the adverse events of febrile seizure and immune thrombocytopenia from DPT and MMR vaccines.

It is a well-established epidemiologic method for evaluating safety and has been used numerous times already to evaluate the Covid-19 vaccines, in the UK (1,2), France and Nordic countries."

https://sensiblemed.substack.com/p/a-level-headed-look-at-the-florida-81a

OP: "This is July 2020; hydroxychloroquine had already been roundly exposed as having minimal evidence for its use for months at this point, and this was a strange intellectual hill on which to die."

Ummm, what was the key takeaway from the link you posted? Was it this, "“This is not a treatment for COVID-19. It doesn’t work,” Martin Landray, an Oxford University professor who is co-leading the RECOVERY trial, told reporters?"

You are dealing with a controversial topic, so it's necessary to look at methods and data, including limitations. What was the key limitation from the RECOVERY trial of HCQ? In NEJM we read, "These findings indicate that hydroxychloroquine is not an effective treatment for hospitalized patients with Covid-19 but do not address its use as prophylaxis or in patients with less severe SARS-CoV-2 infection managed in the community."

What was the stated limitation from the NEJM article? "...do not address its use as prophylaxis or in patients with less severe SARS-CoV-2 infection managed in the community." What is that? A limitation? But Landray, one of the authors said that HCQ doesn't work? Maybe the reporter slightly took Landray's comment out of context. The reporter certainly was ignorant of the limitation stated in the NEJM article.

I agree that HCQ is not appropriate for use in hospitals, from the RECOVERY trial, but it is very effective when given early, within 72 hours of symptom onset, as Accinelli, et. al., found.

"Results

A total...No patient treated within the first 72 h of illness died. The factors associated with higher case fatality rate were age (OR = 1.06; 95% CI 1.01–1.11, p = 0.021), SpO2 (OR = 0.87; 95% CI 0.79–0.96, p = 0.005) and treatment onset (OR = 1.16; 95% CI 1.06–1.27, p = 0.002), being the latter the only associated in the multivariate analysis (OR = 1.18; 95% CI 1.05–1.32, p = 0.005). 0.6% of our patients died."

Time to treatment with HCQ was the most significant factor in mortality.

https://www.sciencedirect.com/science/article/pii/S1477893921002040

So Ladapo made the correct decision to support early treatment with HCQ, because he was following the best scientific evidence available. Then Accinelli came along in Dec. 2021 and clinched the nail. (There have been some 100 studies or so of early treatment with HCQ. Almost all show a signal of benefit, with signal strength depending on the median time of beginning of treatment of patients where the median was close to or within 72 hours of symptom onset.)

And Ladapo, in the case of HCQ, did a better job of understanding the literature than many doctors who were HCQ skeptics.

Now we have to wonder why it took until Dec. 2021 to get the Accinelli data. A Midwestern Doctor might have a clue about this question.

[In my methods, I expect to have to sift baby from bathwater no matter the source. That's simply due diligence that all adults should do. This means that controversial topics need more analysis. And I know when the game changes from science to politics, I need to switch from scientific methods to political/funding analysis.]

https://amidwesterndoctor.substack.com/p/who-owns-the-cdc

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Pershalle's avatar

You should read the Daily Sceptic which is a daily newsletter published in the UK. It has been providing chapter and verse on various studies that seek to answer the key questions (vaccine efficacy and vaccine side-effects) since mid 2020. For example, there is now a LOT of data that suggests that the vaccines are potentially more harmful to children than Covid. My wife and I have decided that, even though we are over 70, we will wait until they approve a conventionally developed vaccine and will not get a mNRA vaccine.

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