Medical Advances Minus the Full Research Apparatus By Brian C.Joondeph, MD

April 10, 2020

Medical Advances Minus the Full Research Apparatus

By Brian C.Joondeph, MD

Anecdotal evidence is based on a real-life event, perhaps just a single occurrence. In medicine and science, much current knowledge began with an anecdote. A famous example occurred in 1928, when Sir Alexander Fleming happened to observe that mold developed on an accidentally contaminated staphylococcus culture plate, and that the mold prevented growth of the bacteria.

This led to the discovery of penicillin, saving countless lives, based on anecdotal evidence of bacteria not growing near a spot of mold. With World War II creating injuries, infections, and sepsis, penicillin was produced in mass, preserving lives and limbs.

Another more recent example comes from my world of retina surgery. An anti-cancer drug, Avastin, was injected

into the eyes of a few patients with advanced macular degeneration. These few patients responded well, anecdotally. After this breakthrough was reported at a retina meeting, it almost immediately became the new treatment standard worldwide.

There were no prospective, randomized clinical trials, considered the gold standard, just the anecdotal observation that this off label treatment worked and saved vision. Despite being the most commonly used treatment for macular degeneration, Avastin is still not FDA approved for this indication.

At the time of inception, the risks were unknown. Could it cause a stroke? Inflammation? Infection? This was a drug that didn’t go through the FDA approval process, at least for injection in the eye, despite it being FDA approved as chemotherapy for metastatic cancer.

Were state governors restricting its use? Were media magpies with little medical knowledge, and even less common sense castigating anyone who dared recommend such an “unproven” and “dangerous” therapy?

Yet here we are in a similar situation with the drug hydroxychloroquine. FDA approved in 1955, doctors have over fifty years experience using it for malaria prevention and various immune diseases such as lupus and rheumatoid arthritis. But look at the abject hysteria from the media, and even the smart set on the task force.

 

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Like any drug, there are potential side effects, some significant, in particular cardiac arrhythmias. Hydroxy shouldn’t be taken by those with a prolonged QT interval on their EKG. This condition affects about 1 in 2500 and is easily found on an EKG. Those traveling to malaria prevalent countries take it for the duration of their travels, from weeks to months.  Longer term, hydroxy can rarely affect vision, but after a minimum of five years of use, not the 5 days or so recommended for Coronavirus treatment or prophylaxis.

Meaning this a well-known and relatively safe drug. Compare this to other commonly prescribed drugs. Anti-depressants can cause suicide and blood thinners may lead to internal bleeding. Even water can cause death if one drinks too much of it.

It so happens that hydroxy has efficacy against the often-deadly Coronavirus. An upstate New York doctor treating a community of Hasidic Jews, reports a 100 percent success rate treating mild to moderate cases with hydroxy, azithromycin, and zinc. The New York Times, showing disdain for upstate New York, orthodox Jews, and anything remotely connected to President Trump, ran this headline,  “Touting virus cure, simple country doctor becomes right-wing star.”

Across the fruited plains to Los Angeles, an emergency medicine specialist also reports “significant success” using hydroxy and zinc, with patients becoming symptom free “within 8 to 12 hours.” Anecdotal evidence, but what’s the alternative?

This exemplifies the leftist elite view against anything promoted by President Trump and promoted by a “simple country doctor” rather than an ivory tower Ivy League grad like Dr Fauci, letting politics trump science. Sound familiar, as in global warming? To the media, saving lives of Coronavirus afflicted is apparently a “right-wing” cause.  Isn’t the left interested in saving lives too? Apparently not.

Ever since President Trump mentioned hydroxy as a potential game changing treatment, the media and the left (sorry to be redundant) have treated hydroxy as rat poison.

Rep Maxine Waters played doctor when she tweeted, “Don’t listen to 45 when he suggests untested hydroxychloroquine to treat COVID19.”

A real doctor, a Mayo Clinic cardiologist warned, “Inexcusable to ignore hydroxychloroquine side effects.” No one is ignoring side effects. Unlike the brainiac who took fishbowl cleaner, hydroxy is available only via a prescription from a licensed physician. It’s the doctor’s job to weigh the risks and benefits of any prescription they write.

Did anyone ask the cardiologist about the reported side effects of Coronavirus, such as several weeks in intensive care, permanent lung dysfunction, heart or kidney damage, or ultimately death?

Scientists want clean data, which can only come via a prospective, randomized clinical trial. This would require a control group, those sick with Coronavirus but willing to receive a placebo rather than hydroxy. How many people, given the widely known “anecdotal evidence,” would be willing to participate in a clinical trial knowing that they may get a placebo rather than hydroxy?

There is plenty of anecdotal evidence that hydroxy works, as this recent American Thinker article outlines. Why not let doctors and patients decide whether to use it, rather than government bureaucrats whose judgement is clouded by political considerations?

Would CNN anti-Trump cranks Chris Cuomo or Dana Bash, afflicted with Coronavirus, be willing to be in a hydroxy trial and take a placebo rather than the “dangerous unproven” potential gamechanger? Anyone want to bet they are both taking hydroxy?

Even NY Governor Andrew Cuomo acknowledges early responses to hydroxy “anecdotally” suggest it’s been “effective,” and is allowing hospital use of the drug. The Michigan governor, after threatening to revoke the medical licenses of physicians who dared to prescribe hydroxy for Coronavirus, did a quick about face, a few days later asking the federal government for hydroxy for her state.

Has Trump derangement syndrome so afflicted the media and the left that their hostility toward hydroxy is based solely on the fact that President Trump promoted it? It sure seems that way.

Attorney General William Barr noticed this too,

Before the president said anything about it, there was fair and balanced coverage of this very promising drug and the fact that it had such a long track record, and soon as [President Trump] said something positive about it the media has been on a jihad to discredit this drug.

So what if the only evidence to date is anecdotal? The scientists of the Coronavirus task force may bristle at anecdotal evidence, but doctors on the front lines, those confronting dying patients rather than journal editorial boards, feel otherwise. An international poll of 6,000 doctors, “Found that the antimalarial drug hydroxychloroquine was the most highly rated treatment for the novel coronavirus.”

In an ideal world, clinical trial data is the gold standard. But when people are losing their eyesight from macular degeneration or their lives from Coronavirus, and the economy is on life support, the axiom, “perfect is the enemy of good” applies. There will be plenty of time for proper studies but now is the time to mitigate disease and save lives.

As President Trump likes to say, “What do you have to lose?”. That’s common sense for most of us, those not poisoned so much by Trump hatred that they want to deny a potential lifesaving treatment to millions of Americans, a treatment that they would demand for themselves or their family members infected with Coronavirus. Take the media hysteria with a grain of salt. Read and discern for yourself.

Brian C Joondeph, MD, is a Denver based physician and freelance writer whose pieces have appeared in American Thinker, Daily Caller, Rasmussen Reports, and other publications. Follow him on Facebook,  LinkedIn, Twitter, and QuodVerum.