Responding to Mr. Gerhard Bedding et. al. (“Drug should be taken seriously, Aug. 17):
Let us look at the science of hydroxychloroquine (HCQ) in the treatment of COVID-19.
One of the first claims that HCQ with azithromycin and zinc is an effective treatment was reported by Didier Raoult in France. This study (www.sciencedirect.com/science/article/pii/S0924857920300996) has multiple flaws. For example: there was no randomization; confounding factors were not accounted for; there were differences in analyzing the data and a disconnect between the number of patients entered into the study (26) and the number of patients data are reported on (20) with no explanation of why the six were excluded from analysis (for a more detailed analysis www.sciencedirect.com/science/article/pii/S0924857920300996).
The study from Henry Ford Hospital in Detroit, claiming positive results (www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext) also has major flaws, the most glaring being the study was retrospective and observational, not randomized; and failed to account for the fact that patients in the HCQ treatment group were twice as likely to receive steroids, which have been shown to be helpful in the treatment of COVID-19.
In contrast, more and more randomized studies have been conducted and the vast majority of those studies (three examples: www.nejm.org/doi/full/10.1056/NEJMoa2016638; www.nejm.org/doi/full/10.1056/NEJMoa2019014; https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1009/5872589 and www.sciencemag.org/news/2020/06/three-big-studies-dim-hopes-hydroxychloroquine-can-treat-or-prevent-covid-19) show that HCQ is of no benefit in early or late treatment or prophylaxis for COVID-19.
The editorial by Dr. Harvey Risch in Newsweek cited by Mr. Bedding et. al. (www.newsweek.com/key-defeating-covid-19-already-exists-we-need-start-using-it-opinion-1519535) is not a scientific article; it is an opinion. Dr. Risch uses the Didier Raoult study cited above and unpublished, non-peer reviewed data by Vladimir Zelenko while ignoring the more recent, randomized, trials. Dr. Risch makes an appeal to authority argument (we should believe him because he is an epidemiologist at Yale), but using the same appeal to authority I can quote Dr. Sten. H. Vermund, M.D., Ph.D., dean of the Yale School of Public Health: “Yale-affiliated physicians used HCQ early in the response to COVID-19, but it is only used rarely at present due to evidence that it is ineffective and potentially risky.”
From the above, I believe one can say that HCQ has been taken seriously. Because HCQ was taken seriously the medication has been researched. As research accumulates, the preponderance of the evidence, at this time, shows HCQ, with or without macrolides or zinc, is not an effective treatment for COVID-19.
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