Friday, June 05, 2020

Trump, Lancet, HCL, Protests, and a Satmar Wedding

Hydroxychloroquine (WSJ)
A couple of things have come up recently that are unrelated to each other but really trouble me. One of them is about the safety and effectiveness of hydroxychloroquine (HCL)  for the treatment of those infected with the COVID-19 virus and the other is about the lack of social distancing at a Satmar wedding a few days ago.

Let me first make clear that with respect to hydroxychloroquine (HCL) I have no particular dog in this hunt.  It means nothing to me personally whether it is a miracle cure or poison. What concerns me is that politics rather than science is making that determination.

There were a couple of limited clinical trials in France that showed promise.When Dr. Zev Zelenko heard about it, he tried using this drug on his COVID patients (in conjunction with zinc). He reported phenomenal success among those of his patients that had HCL administered to them. With no ill effects. 

It was thought by many in the medical community that a drug which has been used safely for over 60 years on patients with malaria and other diseases (lupus and rheumatoid arthritis), would be worth clinical trials. Dr. Zelenko’s anecdotal evidence was not the same as scientific data that would be collected with the much bigger clinical trials. It was nevertheless approved by the FDA for emergency use. 

Meanwhile the World Health Organization (WHO) began massive clinical clinical trial of their own. As did the Veterans Administration.

But then something happened to change all that. 

It was promoted by the President as a possible miracle cure or treatment. That brought out the dogs. First there was a medical journal article that had done some limited clinical trials showing the drug to not be effective at all. And may even increase the chances of death. They made clear that their study was not large enough to be conclusive and that larger studies were needed. But they felt it was worth raising their concern. 

The media delighted in reporting that the President was promoting an ineffective drug that could kill COVID patients. Delighted as well were all the Trump haters that now had more ammo to use against him in the upcoming election. (Not that they needed any. But the more the merrier I suppose.) Then came Lancet, a respected medical journal that reported astonishing results from a very large study. From the Wall Street Journal
Mr. Trump’s critics then seized on the Lancet study on HCL, published May 22, that showed a 30% increase in mortality based on 96,032 Covid-19 patient records that the data company Surgisphere claimed to have collected from 671 hospitals on six continents. The World Health Organization halted its global HCL clinical trial after the study came out, and many countries banned the drug as a Covid treatment
The gleeful mainstream media could not be happier to pile on. Accusing Trump of promoting voodoo medicine. When the President announced that he had himself been taking HCL after being exposed to a valet that tested positive, he was pilloried for using a drug that was now considered deadly. They said when a President does something many people will think it is safe, try it, and end up harming themselves.

Pretty damning stuff. Respected medical journals are saying that this drug can kill you and the President is promoting its use?! What can be worse than that?!

Except that it is all a lie. Lancet was sloppy:
(When) scientists around the world reviewed the Lancet study, they spotted glaring data errors. One example: Obesity and smoking rates in the study were the same across six continents. In a letter to Lancet’s editors last week, 120 scientists criticized the study’s sloppiness and aggregation of patients who were different in many respects including HCL dosages and the severity of illness.
The study also had not undergone an ethics review, they pointed out, and Lancet had broken its pledge to share all data and code on Covid studies. Surgisphere’s CEO Sapan Desai was one of the study’s authors and claimed his hospital contracts did not allow the data to be shared. This raised more red flags.
On Wednesday the Guardian published an investigation of Surgisphere that raises questions about how it obtained so many patient records from around the world given privacy and technical challenges. Surgisphere’s LinkedIn page early Wednesday identified only three employees. Mr. Desai said he has initiated a “third-party audit of that paper in collaboration with The Lancet.” 
WHO has now resumed its clinical trials.

What does all this mean? It means that the bias against the President is so visceral that even respected medical journals will  be blinded by it. I see no other reason for smearing a drug that had shown so much promise in the beginning.

I have no clue whether HCL is actually effective or not. Nor do I know whether the risks of taking it outweigh the benefits. Risks that have not deterred doctors from widely prescribing HCL for the above-mentioned diseases for over 60 years! The point is that no one knows anything for certain yet and the studies should be continued. The disruption of these studies because of anti Trump politics did not help anyone.

Satmar wedding in Williamsburg last week (Chanel 10 news - Israel)
Now the other issue.The Satmar Rebbe secretly held a huge wedding for his grandson in Williamsburg last week. Totally ignoring the social distancing guidelines designed to prevent the spread of COVID-19.

I have not been reticent in my criticism of Satmar and like minded Chasidim for treating the pandemic sheltering requirements as ruse foisted upon Jews by the government for purposes of denying religious rights. There were many clandestine events over the last few months that had similarly ignored those guidelines. In all cases endangering themselves and those who they come into contact with. 

Their contempt for the government – seeing them always in the context of Esav Sonei L’Yaakov - is appalling. Especially when the rules they are violating do not exclusively apply to them. They apply to everyone. Jew and gentile alike. Making matters worse is the high rate of infection that has happened in these communities. (As attested to by the above-mentioned Dr. Zelenko who served the Satmar town of Kiryas Joel.)

One of many massive protests last week (KPIX)
That being said. there needs to be a bit of perspective here. That threat of spreading the virus by Satmar because so many Chasidim attended a wedding is minuscule compared to the vast numbers of people this week protesting police brutality in this country (and all over the world). 

There was absolutely no social distancing in those crowds. If there is a spike in the disease, it will be far more likely be caused by millions of people protesting. To complain about a few thousand Satmar Chasdidm that attended a wedding as a source for a possible spike is ridiculous compared to the millions protesting together. 

This does not absolve Satmar. Nor am I saying those protests weren’t justified. From a social justice perspective they were. But from a public health perspective – not so much.

The bottom line for me on both of these issues (HCL and Satmar) is truth. There are no politics to truth. Truth should be sought wherever it can be found.