PatCosta.com

So what is really going on with hydroxychloroquine (HCQ)? There are lots of conflicting studies pointing to one conclusion or the other. It is worth reviewing how the sausage is made. The gold standard is a randomized double-blind study with a large N, where participants are randomly put into two groups. One is given a placebo and another is given the treatment. Measurements are taken and effects are observed. Various things are controlled for like age and gender.

If the treatment is better than chance it is considered effective. Though effects can be weak, moderate, or strong. Ideally, strong is what you want meaning it is much, much, much greater than chance. Then the results are published and hopefully replicated. When all that happens we can say the treatment is better than chance and start using it.

This is considered to be the best kind of study design. 

Then there is the issue of measurement. How do you measure the HCQ effect? Do you ask patients how they feel? Do you count the number of breaths they can do on their own? Do you look at fatalities? Time spent in the hospital? Something else?

Besides measurement, you need to have a large N, or population. 10 people won’t cut it but 10,000 might. 

There are variables to consider such as the type of population (old people vs. young as an example), the degree of COVID (mild, moderate, strong), the dosage amount, how many doses, where they are along with the disease (the start vs the end), and what else you add with HCQ such as AZ. There might also be variables that we don’t know about. 

Lastly, HCQ has anti-viral, anti-inflammation, and anti-thrombotic properties. It is hard to tease out what about HCQ is helpful.

The NIH and WHO studies were stopped because the data in their design showed the drug to be ineffective. That doesn’t mean HCQ works or doesn’t work only it didn’t with their design. Other studies were stopped because HCQ was causing cardiac issues which makes sense because the kinds of people who end up in a hospital for COVID are older and/or have underlying health issues which are exacerbated with an HCQ treatment. 

It is probably likely that HCQ has some kind of benefit but under what circumstance and for who exactly is not known.

However, it is infuriating that scientists will often make loud proclamations about what works or doesn’t, rather than letting the evidence decide and the peer review process plays out.

Let’s use one as an example. Harvey Risch published an opinion piece in a July 2020 Newsweek titled: The Key to Defeating COVID-19 Already Exists. We Need to Start Using It. In it, he argues that he should be using Hydroxychloroquine.

However, the argument has major flaws outlined below. Just because a Yale Dr publishes an opinion piece in Newsweek does not mean it is free of bad arguments.

1. The opinion piece cherry-picks studies. I mean I could cherry-pick all the negative studies which show it doesn’t work. Indeed, one of the studies he alludes to from Gautret et al 2020 could be fraudulent. Some data used in that study appears to not exist.

Dahly et al. 2020 in their preprint article called: Statistical review of Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial (link to pdf) provide an extensive and exhaustive review of Gautret et al 2020.

2. The studies he cites do not use the gold standard, ie: Studies that are double-blind randomized ones. He even mentions this in his own study.

3. He is arguing that the drug works only at the start of the disease but if it strongly inhibits coronavirus replication, there’s no reason that it couldn’t be effective both in the middle/end of the disease and at the start.

4. The author fails to point out the alternative rival hypotheses that caused the Swiss deaths to revert. It is sad to see a Dr. fail to understand correlation is not causation.

This article: Hydroxychloroquine to treat COVID-19: Evidence can’t seem to kill it is a good rebuttal of that Newsweek Opinion piece and goes into more detail of those four points.

For further review of HCQ studies see https://c19study.com/.

For papers that have been retracted, see: https://retractionwatch.com/

While on the same topic, yes, Masks work: https://www.wsj.com/articles/face-masks-really-do-matter-the-scientific-evidence-is-growing-11595083298?mod=e2tw

Opinion Articles:

Edmund Burke: https://www.nytimes.com/2020/08/05/opinion/edmund-burke.html

David Brooks: https://www.nytimes.com/2020/08/07/opinion/sunday/republican-party-trump-2020.html

Non-delegation doctrine:

The non-delegation doctrine is essentially the idea that Congress should make all the administrative laws rather than just the legal laws. So instead of relying on a government agency to carry out the law, Congress would tell the govt agency exactly how to carry out the law.

This non-delegation doctrine is bunk. Congress has been delegating powers of governance since its founding: https://www.theatlantic.com/ideas/archive/2020/05/nondelegation-doctrine-orliginalism/612013/. There is no historical evidence to support the idea. More to the point, this idea of non-delegation arose at the same time as the administrative/welfare state.

So it is less a constitutional theory and more a reaction by ideologues for things they disagree with.

For a collection of articles that highlight specifically the urban/rural divide see: What’s Up With Rural America and How to Fix It.

There is so much misinformation out there about the Trump administration’s new “zero tolerance” policy that requires criminal prosecution, which then warrants the separating of parents and children at the border. Before responding to a post defending this policy, please do your research.

Myth 1: This is not a new policy and was practiced under Obama and Clinton –

FALSE. The policy to separate parents and children is new and was instituted on 4/6/2018. It was the brainchild of John Kelly and Stephen Miller to serve as a deterrent for undocumented immigration, approved by Trump, and adopted by Sessions. Prior administrations detained migrant families, but didn’t have a practice of forcibly separating parents from their children unless the adults were deemed unfit. https://www.justice.gov/…/press-rele…/file/1049751/download…

Myth 2: This is the only way to deter undocumented immigration –

FALSE. Annual trends show that arrests for undocumented entry are at a 46 year low, and undocumented crossings dropped in 2007, with a net loss (more people leaving than arriving). Deportations have increased steadily though (spiking in 1996 and more recently), because several laws that were passed since 1996 have made it legally more difficult to gain legal status for people already here, and thus increased their deportations (I address this later under the myth that it’s the Democrats’ fault). What we mostly have now are people crossing the border illegally because they’ve already been hired by a US company, or because they are seeking political asylum. Economic migrants come to this country because our country has kept the demand going. But again, many of these people impacted by Trump’s “zero tolerance” policy appear to be political asylum-seekers. https://www.npr.org/…/arrests-for-illegal-border-crossings-…

Myth 3: Most of the people coming across the border are just trying to take advantage of our country by taking our jobs –

FALSE. Most of the parents who have been impacted by Trump’s “zero tolerance” policy have presented themselves as political asylum-seekers at a U.S. port-of-entry, from El Salvador, Guatemala, and Honduras. Rather than processing their claims, they have been taken into custody on the spot and had their children ripped from their arms. The ACLU alleges that this practice violates the Asylum Act, and the UN asserts that it violates the UN Treaty on the State of Refugees, one of the few treaties the US has ratified. This is an illegal act on the part of the United States government, not to mention morally and ethically reprehensible. https://www.nytimes.com/…/meatpackers-profits-hinge-on-pool…

Myth 4: We’re a country that respects the Rule of Law, and if people break the law, this is what they get –

FALSE. We are a country that has an above-ground system of immigration and an underground system. Our government (under both parties) has always been aware that US companies recruit workers in the poorest parts of Mexico for cheap labor, and ICE (and its predecessor INS) has looked the other way because this underground economy benefits our country to the tune of billions of dollars annually. Thus, even though the majority of people crossing the border now are asylum-seekers, those who are economic migrants (migrant workers) likely have been recruited here to do jobs Americans will not do. https://www.upi.com/…/Donald-Trumps-wall-ign…/2621477498203/

Myth 5 : The children have to be separated from their parents because there parents must be arrested and it would be cruel to put children in jail with their parents –

FALSE. First, in the case of economic migrants crossing the border illegally, criminal prosecution has not been the legal norm, and families have been kept together at all cost. Also, crossing the border without documentation is a typically a misdemeanor not requiring arrest, but rather a civil proceeding. Additionally, parents who have been detained have historically been detained with their children in ICE “family residential centers,” again, for civil processing. The Trump administration’s shift in policy is for political purposes only, not legal ones. See p. 18: https://www.aclu.org/…/ms-l-v-ice-plaintiffs-opposition-def…

Myth 6: We have rampant fraud in our asylum process the proof of which is the significant increase we have in the number of people applying for asylum.

FALSE. The increase in asylum seekers is a direct result of the increase in civil conflict and violence across the globe. While some people may believe that we shouldn’t allow any refugees into our country because “it’s not our problem,” neither our current asylum law, nor our ideological foundation as a country support such an isolationist approach. There is very little evidence to support Sessions’ claim that abuse of our asylum-seeking policies is rampant. Also, what Sessions failed to mention is that the majority of asylum seekers are from China, not South of the border. Here is a very fair and balanced assessment of his statements: http://www.politifact.com/…/jeff-sessions-claim-about-asyl…/

Myth 7: The Democrats caused this, “it’s their law.”

FALSE. Neither the Republicans nor the Democrats caused this, the Trump administration did (although the Republicans could fix this today, and have refused). I believe what this myth refers to is the passage of the Illegal Immigration Reform and Immigrant Responsibility Act, which were both passed under Clinton in 1996. These laws essentially made unauthorized entry into the US a crime (typically a misdemeanor for first-time offenders), but under both Republicans and Democrats, these cases were handled through civil deportation proceedings, not a criminal proceeding, which did not require separation. And again, even in cases where detainment was required, families were always kept together in family residential centers, unless the parents were deemed unfit (as mentioned above). Thus, Trump’s assertion that he hates this policy but has no choice but to separate the parents from their children, because the Democrats “gave us this law” is false and nothing more than propaganda designed to compel negotiation on bad policy. https://www.independent.co.uk/…/trump-democrats-us-border-m…

Myth 7: The parents and children will be reunited shortly, once the parents’ court cases are finalized.

FALSE. Criminal court is a vastly different beast than civil court proceedings. Also, the children are being processed as unaccompanied minors (“unaccompanied alien children”), which typically means they are sent into the custody of the Office of Refugee Resettlement (ORR), which is part of the Department of Health and Human Services (DHS). Under normal circumstances when a child enters the country without his or her parent, ORR attempts to locate a family member within a few weeks, and the child is then released to a family member, or if a family member cannot be located, the child is placed in a residential center (anywhere in the country), or in some cases, foster care. Prior to Trump’s new policy, ORR was operating at 95% capacity, and they simply cannot effectively manage the influx of 2000+ children, some as young as 4 months. Also, keep in mind, these are not unaccompanied minor children, they have parents. There is great legal ambiguity on how and even whether the parents will get their children back because we are in uncharted territory right now. According to the ACLU lawsuit (see below), there is currently no easy vehicle for reuniting parents with their children. Additionally, according to a May 2018 report, numerous cases of verbal, physical and sexual abuse were found to have occurred in these residential centers. https://www.aclu.org/…/aclu-obtains-documents-showing-wides…

Myth 8: This policy is legal.

LIKELY FALSE. The ACLU filed a lawsuit against the Trump administration on 5/6/18, and a recent court ruling denied the government’s motion to dismiss the suit. The judge deciding the case stated that the Trump Administration policy is “brutal, offensive, and fails to comport with traditional notions of fair play and decency.” The case is moving forward because it was deemed to have legal merit.https://www.bloomberg.com/…/aclu-suit-over-child-separation…