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I am going to use this as a page to develop articles. I already have one that I was working on for another site, but I need a place to fix it as some of the markup language is different (plus it still needs some editing).

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I am going to use this as a page to develop articles. I already have one that I was working on for another site, but I need a place to fix it as some of the markup language is different (plus it still needs some editing).

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====1. The data was too clean====

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{{cquote|About the paper published in ''The Lancet'': Data coming from five different continents cannot be so homogeneous. There is either data manipulation (not mentioned in Material and Methodes), or incorporation of faked data. - Dr. Didier Raoult<ref name=Raoulttweet>[https://twitter.com/raoult_didier/status/1265291857866764288?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1265291857866764288%7Ctwgr%5E&ref_url=https%3A%2F%2Ffreewestmedia.com%2F2020%2F05%2F28%2Fdidier-raoult-dismisses-lancet-study-as-lousy%2F Dr. Didier Raoult's twitter post] by Dr. Didier Raoult (May 26, 2020) ''Twitter''</ref>}}

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{{cquote|About the paper published in ''The Lancet'': Data coming from five different continents cannot be so homogeneous. There is either data manipulation (not mentioned in Material and Methodes), or incorporation of faked data. - Dr. Didier Raoult<ref name=Raoulttweet>[https://twitter.com/raoult_didier/status/1265291857866764288?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1265291857866764288%7Ctwgr%5E&ref_url=https%3A%2F%2Ffreewestmedia.com%2F2020%2F05%2F28%2Fdidier-raoult-dismisses-lancet-study-as-lousy%2F Dr. Didier Raoult's twitter post] by Dr. Didier Raoult (May 26, 2020) ''Twitter''</ref>}} People from different countries have different cultures and this results in different behaviors and lifestyles among their citizens. One example mentioned by both Dr. Didier Raoult and Dr. Chris Martenson was smoking. In North America and Australia, rates of smoking are closer to 14% and in Europe it is closer to 20 - 30%.<ref name=Csmoke>[https://www.youtube.com/watch?v=uggOJcZBFoI&list=PLRgTUN1zz_oeQpnJxpeaEkFimDeepqyWf&t=970 Grim Milestone: 100k+ US Coronavirus Deaths] by Chris Martenson (May 26,2020) ''PeakProsperity''</ref><ref>[https://blog.euromonitor.com/lighting-up-or-putting-out-global-trends-in-smoking-prevalence/ Lighting Up or Putting Out? Global Trends in Smoking Prevalence] (07/31/2013) ''Euromonitor International''</ref> One would expect this variation in smoking prevalence to be reflected in the study's data set, but the authors claimed that 10% of North Americans, 9.7% of South Americans, 9.7% of Europeans, 10.3% of Africans, 9.4% of Asians, and 10.0% of Asians in the study smoked.<ref name =Lancetstrikesagain/> This discrepancy made the data appear fake, which was the point Dr. Raoult was making in his tweet.

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People from different countries have different cultures and this results in different behaviors and lifestyles among their citizens. One example mentioned by both Dr. Didier Raoult and Dr. Chris Martenson was smoking. In North America and Australia, rates of smoking are closer to 14% and in Europe it is closer to 20 - 30%.<ref name=Csmoke>[https://www.youtube.com/watch?v=uggOJcZBFoI&list=PLRgTUN1zz_oeQpnJxpeaEkFimDeepqyWf&t=970 Grim Milestone: 100k+ US Coronavirus Deaths] by Chris Martenson (May 26,2020) ''PeakProsperity''</ref><ref>[https://blog.euromonitor.com/lighting-up-or-putting-out-global-trends-in-smoking-prevalence/ Lighting Up or Putting Out? Global Trends in Smoking Prevalence] (07/31/2013) ''Euromonitor International''</ref> One would expect this variation in smoking prevalence to be reflected in the study's data set, but the authors claimed that 10% of North Americans, 9.7% of South Americans, 9.7% of Europeans, 10.3% of Africans, 9.4% of Asians, and 10.0% of Asians in the study smoked.<ref name =Lancetstrikesagain/> This discrepancy made the data appear fake, which was the point Dr. Raoult was making in his tweet.

Another problem with clean data was pointed out by the twitter user arkancideisreal.

{{cquote|This (Table S7B) gives more of a breakdown of the data and uses something called "propensity matching". This is a method of matching up similar patients. So for instance you want to get the same proportions of black/white patients in each group. Same for BMI, smoking, etc.

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Each time you do this for each factor you reduce the pool of patients to compare. So to get the same number of black, non-smoking, BMI 25, hypertensive people in each group is really tough (5 factors) This group did it with 23 factors, all matched up "perfectly". This is pretty much statistically impossible.<ref name =arkancide>[https://twitter.com/Arkancideisreal/status/1264032084944814082 Arkanacideisreal's twitter post] by arkancideisreal (May 22,2020) ''Twitter''</ref>}}

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Each time you do this for each factor you reduce the pool of patients to compare. So to get the same number of black, non-smoking, BMI 25, hypertensive people in each group is really tough (5 factors) This group did it with 23 factors, all matched up "perfectly". This is pretty much statistically impossible.<ref name =arkancide>[https://twitter.com/Arkancideisreal/status/1264032084944814082 Arkanacideisreal's twitter post] by arkancideisreal (May 22,2020) ''Twitter''</ref>}} The objective of propensity matching is to try and account for the influence of confounding variables. For example, one doesn't want more obese people to be in the HCQ group when compared to the non-HCQ group because obesity is a comorbidity and any observed increase in deaths could be due to this confounding variable. To try and eliminate this problem, researchers will reduce the number of patients they are comparing so that they have patient groups that are highly similar. Once one gets out to 23 factors, the likelihood that a large number of patients in the HCQ group will have similar statistics as a large number of patients in the control group is vanishingly small, thus table S7B strongly suggests that the authors lied.

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The objective of propensity matching is to try and account for the influence of confounding variables. For example, one doesn't want more obese people to be in the HCQ group when compared to the non-HCQ group because obesity is a comorbidity and any observed increase in deaths could be due to this confounding variable. To try and eliminate this problem, researchers will reduce the number of patients they are comparing so that they have patient groups that are highly similar. This type of analysis is difficult for 5 factors because each time you add a factor, people will be eliminated from the group and their elimination will effect the other variables being controlled for. For example, if one had 7 Asian individuals in both the HCQ and control groups and two of the Asians in the HCQ group were eliminated because their body mass index was too high but all 7 Asians in the control group remained, now the Asian confounding variable isn't being accounted for. Once one gets out to 23 factors, the likelihood that a large number of patients in the HCQ group will have similar statistics as a large number of patients in the control group is vanishingly small, thus table S7B strongly suggests that the authors lied.

====2. Impossible to collect the data in a month and a half without violating privacy laws====

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{{cquote|Usually to submit to a database like Surgisphere you need ethics approval, and someone from the hospital will be involved in that process to get it to a database. - Dr. Allen Cheng<ref name =Guardian>[https://www.theguardian.com/science/2020/may/28/questions-raised-over-hydroxychloroquine-study-which-caused-who-to-halt-trials-for-covid-19 Questions raised over hydroxychloroquine study which caused WHO to halt trials for Covid-19] by Melissa Davey (27 May 2020 22.27 EDT) ''The Guardian''</ref>}}

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{{cquote|Usually to submit to a database like Surgisphere you need ethics approval, and someone from the hospital will be involved in that process to get it to a database. - Dr. Allen Cheng<ref name =Guardian>[https://www.theguardian.com/science/2020/may/28/questions-raised-over-hydroxychloroquine-study-which-caused-who-to-halt-trials-for-covid-19 Questions raised over hydroxychloroquine study which caused WHO to halt trials for Covid-19] by Melissa Davey (27 May 2020 22.27 EDT) ''The Guardian''</ref>}} Pretty much all countries except China have strict privacy laws. This is particularly true for western countries in regards to their citizen's health data and yet ''The Lancet'' study said that patient data had been collected from Europe, Australia, and North America in a really short time frame. This fact leads inquiring minds to ask "How did they get the data?" Surgisphere, the company behind the paper, said they questioned existing repositories of data. While some electronic repositories of health data do exist, each hospital system has their own repository that is not linked to the repositories of other hospital systems and access to each repository requires its own ethical approval. Obtaining such approval is not easy, particularly when one has to do it for multiple different countries, each of whom has their own unique set of rules and regulations surrounding access to patient records. Even if one were to gain access, all the information one wishes to include (such as whether or not a patient was a former smoker) may not have been entered into the database by the hospital. Moreover, one would need to gain access to ''pathology'' databases which are complete separate from ''hospital record'' databases ''and'' be able to match the information from pathology databases to a particular individual's hospital record.<ref name =arkancide/><ref name =Guardian/> Maybe in China that is possible, but not in western countries unless one is a doctor or nurse of that particular patient.

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Pretty much all countries except China have strict privacy laws. This is particularly true for western countries in regards to their citizen's health data and yet ''The Lancet'' study said that patient data had been collected from Europe, Australia, and North America in a really short time frame. This fact leads inquiring minds to ask "How did they get the data?" Surgisphere, the company behind the paper, said they questioned existing repositories of data. While some electronic repositories of health data do exist, each hospital system has their own repository that is not linked to the repositories of other hospital systems and access to each repository requires its own ethical approval. Obtaining such approval is not easy, particularly when one has to do it for multiple different countries, each of whom has their own unique set of rules and regulations surrounding access to patient records. Even if one were to gain access, all the information one wishes to include (such as whether or not a patient was a former smoker) may not have been entered into the database by the hospital. Moreover, one would need to gain access to ''pathology'' databases which are complete separate from ''hospital record'' databases ''and'' be able to match the information from pathology databases to a particular individual's hospital record.<ref name =arkancide/><ref name =Guardian/> Maybe in China that is possible, but not in western countries unless one is a doctor or nurse of that particular patient.

====3. Only four authors====

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{{cquote|Usually with studies that report on findings from thousands of patients, you would see a large list of authors on the paper. Multiple sources are needed to collect and analyse the data for large studies and you usually see that acknowledged in the list of authors.” - Dr. Allen Cheng<ref name =Guardian/>}}

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{{cquote|Usually with studies that report on findings from thousands of patients, you would see a large list of authors on the paper. Multiple sources are needed to collect and analyse the data for large studies and you usually see that acknowledged in the list of authors.” - Dr. Allen Cheng<ref name =Guardian/>}} The ''Lancet'' study had only four authors, three of whom were heart specialists and therefore were not responsible for data collection or statistical analysis.

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The ''Lancet'' study had only four authors, three of whom were heart specialists and therefore were not responsible for data collection or statistical analysis.

====4. Too many Australian deaths====

The following was also revealed in ''The Guardian'' article the quotes from Dr. Allen Cheng came from.

{{cquote|The study, led by the Brigham and Women’s Hospital Center for Advanced Heart Disease in Boston, examined patients in hospitals around the world, including in Australia. It said researchers gained access to data from five hospitals recording 600 Australian Covid-19 patients and 73 Australian deaths as of 21 April.

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But data from Johns Hopkins University shows only 67 deaths from Covid-19 had been recorded in Australia by 21 April. The number did not rise to 73 until 23 April. The data relied upon by researchers to draw their conclusions in the ''Lancet'' is not readily available in Australian clinical databases, leading many to ask where it came from.<ref name =Guardian/>}}

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But data from Johns Hopkins University shows only 67 deaths from Covid-19 had been recorded in Australia by 21 April. The number did not rise to 73 until 23 April. The data relied upon by researchers to draw their conclusions in the ''Lancet'' is not readily available in Australian clinical databases, leading many to ask where it came from.<ref name =Guardian/>}} Yep. That is a problem, but it gets worse for Surgisphere...

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Yep. That is a problem, but it gets worse for Surgisphere...

====5. Two of the authors were related====

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{{cquote|And the story is not that I am related to Dr. Desai by marriage. That’s old news. Many people from the Brigham were at that wedding and media knew about it. Despite this I still do not have the information of what happened at Surgisphere. But there has to be locals who do.<ref>[https://twitter.com/DoctorAmitPatel/status/1269805857824522242?s=20 Dr. Amit Patel's Twitter post] by Dr. Amit Patel (June 7, 2020) ''Twitter''</ref> - Dr. Amit Patel}}

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{{cquote|And the story is not that I am related to Dr. Desai by marriage. That’s old news. Many people from the Brigham were at that wedding and media knew about it. Despite this I still do not have the information of what happened at Surgisphere. But there has to be locals who do.<ref>[https://twitter.com/DoctorAmitPatel/status/1269805857824522242?s=20 Dr. Amit Patel's Twitter post] by Dr. Amit Patel (June 7, 2020) ''Twitter''</ref> - Dr. Amit Patel}} No conflict of interest there...

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No conflict of interest there...

====6. And there were even more problems...====

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===The RECOVERY Trial===

Another study commonly cited by the media is the UK's RECOVERY Trial<ref name =Recovery>[https://www.recoverytrial.net/files/protocol-archive/recovery-protocol-v6-0-2020-05-14.pdf/@@download Randomised Evaluation of COVID-19 Therapy (RECOVERY)] by Peter Horby et al. Version 6 (2020-05-14)</ref>, which is a comprehensive evaluation of possible treatment options for COVID-19. HCQ was one of the drugs tested, but the results were not statistically significant. The following is how Professor Peter Horby and Professor Martin Landray presented their findings.

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{{quotebox|<nowiki>A total of 1542 patients were randomised to hydroxychloroquine and compared with 3132 patients randomised to usual care alone. There was no significant difference in the primary endpoint of 28-day mortality (25.7% hydroxychloroquine vs. 23.5% usual care; hazard ratio 1.11 [95% confidence interval 0.98-1.26]; p=0.10). There was also no evidence of beneficial effects on hospital stay duration or other outcomes. ‘These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients</nowiki> ''hospitalised'' with COVID-19. Full results will be made available as soon as possible.<ref>[https://www.ox.ac.uk/news/2020-06-05-no-clinical-benefit-use-hydroxychloroquine-hospitalised-patients-covid-19 No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19] by Chief Investigators of the Randomised Evaluation of COVid-19 thERapY (5 JUN 2020) ''University of Oxford''</ref>}}

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{{quotebox|<nowiki>A total of 1542 patients were randomised to hydroxychloroquine and compared with 3132 patients randomised to usual care alone. There was no significant difference in the primary endpoint of 28-day mortality (25.7% hydroxychloroquine vs. 23.5% usual care; hazard ratio 1.11 [95% confidence interval 0.98-1.26]; p=0.10). There was also no evidence of beneficial effects on hospital stay duration or other outcomes. ‘These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients</nowiki> ''hospitalised'' with COVID-19. Full results will be made available as soon as possible.<ref>[https://www.ox.ac.uk/news/2020-06-05-no-clinical-benefit-use-hydroxychloroquine-hospitalised-patients-covid-19 No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19] by Chief Investigators of the Randomised Evaluation of COVid-19 thERapY (5 JUN 2020) ''University of Oxford''</ref>}} That statement is not correct. If the study convincingly ruled out HCQ, it would have a p value less than .05.<ref name =Changingtimes>[https://changingtimes.media/2020/06/21/covid-19-hydroxychloroquine-treatment-rejected-by-giants-of-the-global-health-establishment/ Covid-19: hydroxychloroquine treatment rejected by giants of the global health establishment] by Annette Gartland (June 21, 2020) ''Changing Times''</ref> It didn't. It had a p value of .10.

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That statement is not correct. If the study convincingly ruled out HCQ, it would have a p value less than .05.<ref name =Changingtimes>[https://changingtimes.media/2020/06/21/covid-19-hydroxychloroquine-treatment-rejected-by-giants-of-the-global-health-establishment/ Covid-19: hydroxychloroquine treatment rejected by giants of the global health establishment] by Annette Gartland (June 21, 2020) ''Changing Times''</ref> It didn't. It had a p value of .10.

In any case, the researchers were correct to conclude that the study only applies to ''hospitalized'' patients and therefore can't be used to conclude that HCQ won't work for people who use the drug closer to the time they were infected. A useful analogy is thinking of COVID-19 like a car crash and HCQ as an airbag. In order for for an airbag to be effective, it has to be deployed after the car crash but before the occupant crashes through the windshield. In the case of Covid-19, the argument is that anti-virals such as HCQ must be deployed after catching the virus but ''before'' it causes massive damage... having the airbag deployed after one hits the windshield just doesn't work. By focusing only on hospitalized patients, the RECOVERY trial failed to address the more pertinent issue of whether HCQ can be used to treat the disease ''before'' one has to be hospitalized.

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The following is how the authors presented their results.

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{{cquote|The ''incidence'' of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was −2.4 percentage points (95% confidence interval, −7.0 to 2.2; <nowiki>P=0.35)</nowiki>.<ref>[https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query%3Dfeatured_home= A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19] by David R. Boulware et. al. (June 3, 2020) ''The New England Journal of Medicine''</ref>}}

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{{cquote|The ''incidence'' of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was −2.4 percentage points (95% confidence interval, −7.0 to 2.2; <nowiki>P=0.35)</nowiki>.<ref>[https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query%3Dfeatured_home= A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19] by David R. Boulware et. al. (June 3, 2020) ''The New England Journal of Medicine''</ref>}} Dr. Cohen counterargues-

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{{cquote|In the current trial, the long delay between perceived exposure to SARS-CoV-2 and the initiation of hydroxychloroquine (≥3 days in most participants) suggests that what was being assessed was prevention of symptoms or progression of COVID-19, rather than prevention of SARS-CoV-2 infection."<ref name=Cohen/>}} In other words, the study ''cannot'' be used to assess HCQ's ability to prevent ''incidence'' like Boulware claimed because the participants weren't given the drugs quickly enough.

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Dr. Cohen counterargues-

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{{cquote|In the current trial, the long delay between perceived exposure to SARS-CoV-2 and the initiation of hydroxychloroquine (≥3 days in most participants) suggests that what was being assessed was prevention of symptoms or progression of COVID-19, rather than prevention of SARS-CoV-2 infection."<ref name=Cohen/>}}

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In other words, the study ''cannot'' be used to assess HCQ's ability to prevent ''incidence'' like Boulware claimed because the participants weren't given the drugs quickly enough.

The French newspaper ''France Soir'' looked at the study's data and concluded HCQ had some benefit for individuals treated for COVID-19 1-2 days after exposure (at 90% confidence, which doesn't quite make it to p <.05). ''France Soir'' also reported that Dr. Boulware scheduled a presentation for October 5, 2019 where he disclosed having received a research grant from Gilead Sciences.<ref>[http://www.francesoir.fr/societe-sante/le-diable-est-vraiment-dans-le-detail-apres-lancet-nous-remettons-en-cause-le-new Le diable est VRAIMENT dans le détail, après The Lancet, nous remettons en cause le New England Journal of Medecine.] by The Citizens’ Collective for ''FranceSoir'' (May 4, 2020) ''FranceSoir''</ref> Gilead is the maker of remdesivir. To Boulware's credit, he recognizes the study's flaws. According to Dr. Lewis, "He also points out that day 1-3 use had statistical significance and he’s gearing his other studies accordingly. He intends to investigate this significance further."<ref>[https://c19study.com/boulware.html COVID-19 Treatment Analysis: Boulware et al. Comments] by CovidAnalysis (accessed July 31, 2020)</ref>

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The study failed to reach statistical significance which should be unsurprising given its limitations. The results were positive, however, with HCQ having a P value of .21 for lower rate of ongoing symptoms and a P value of .29 for a lower rate of hospitalization.<ref>[https://pubmed.ncbi.nlm.nih.gov/32673060/ Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19: A Randomized Trial] by Caleb P Skipper et. al. (2020 Jul 16) ''Annals of Internal Medicine''</ref>

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===Retrospective studies from New York===

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===Retrospective studies from New York==

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There is no question that retrospective studies are not the best science. One has to use statistics to try and account for all kinds of variables such as delayed onset of treatment, not giving a patient a drug due to a patient's risk factors, and other variables such as differences in comorbidities. Some of these factors can be controlled for in certain situations. For example, if patients are seen by the same group of doctors, then differences such as when a particular drug is administered may not vary widely, but even in that situation other variables will persist such as screening for risk factors. The main advantage of retrospective studies is that ethical concerns are limited to protecting patient privacy as no patients are being given placebos or potentially harmful drugs.

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In the case of New York, three large, retrospective studies for hosptilized patients were conducted, two of which said HCQ treatment had no effect, and a third which said HCQ had a net benefit.

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In the case of New York, three retrospective studies were conducted, two of which said HCQ treatment had no effect, and a third which said HCQ had a net benefit.

====Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19====

Joshua Geleris studied the patients who came to the New York–Presbyterian Hospital (NYP)–Columbia University Irving Medical Center (CUIMC). Having the results come from one hospital could mean that some of the variables one might encounter with a multi-hospital analysis are controlled for, that doesn't hold true in this case. While the hospital initially recommended dosing for HCQ at 400 mg, these recommendations were subsequently removed and treatment was left to the doctor's discretion. Moreover, it was only until after patients reached the emergency room that they were given HCQ (see figure S3), and even then only 45.8% received it within 24 hours. That is pretty late to be giving HCQ. In any case, what did they find?

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{{Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses.<ref>[https://www.nejm.org/doi/10.1056/NEJMoa2012410?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19] by Joshua Geleris et.al (June 18, 2020) ''The New England Journal of Medicine''</ref>}}

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{{Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses.<ref>[https://www.nejm.org/doi/10.1056/NEJMoa2012410?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19] by Joshua Geleris et.al (June 18, 2020) ''The New England Journal of Medicine''</ref>}} In short, the researchers found that if you give HCQ in an ER preferentially to patients who were more severely ill at baseline, there is no significant difference between those given HCQ and those who weren't given it. It is difficult to figure out how to interpret that result. Is there no effect in an ER setting as evidenced by the similarity of outcomes between the two groups? Does it mean that there was a net positive effect to HCQ because the sicker patients weren't dying as often as one might otherwise expect?

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In short, the researchers found that if you give HCQ in an ER preferentially to patients who were more severely ill at baseline, there is no significant difference between those given HCQ and those who weren't given it. It is difficult to figure out how to interpret that result. Is there no effect in an ER setting as evidenced by the similarity of outcomes between the two groups? Does it mean that there was a net positive effect to HCQ because the sicker patients weren't dying as often as one might otherwise expect?

The short answer? Nobody really knows because there are too many variables not being accounted for.

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The study divided patients into ambulatory and hospitalized sub-groups. Ambulatory was defined as "patients whose encounter was an office visit, emergency department (ED) visit, or telehealth/telemedicine." Hospitalized was defined as "inpatients and ambulatory patients who were subsequently admitted to the hospital." This subdivision is important as it helps control for two of the most important factors, namely the timing of HCQ use and the overall health of the patients using the drug. Because of its sheer size, the study was able to do this subdivision without impacting its ability to achieve statistically significant results... even the subdivisions were larger than the studies conducted by Geleris and Rosenberg. The subgroups were then further subdivided into survivors and non-survivors, with the end date being April 17, 2020 (meaning a patient had to have died or discharged by that date to be included in the study). Then they did a whole bunch of statistical stuff (Cox Regression analysis, inverse probability weighting (IPTW) based on propensity scoring) to determine what the statistical results were.<ref name=MountSanai>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325642/#MOESM1 Risk Factors for Mortality in Patients with COVID-19 in New York City] by Takahisa Mikami (2020 Jun 30) ''Journal of General Internal Medecine''</ref> So what did they find?

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{{A total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio [HR] 2.34, CI 1.47–3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06–1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13–1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56–2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m2 (HR 1.80, CI 1.60–2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12–2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02–1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23–1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77–0.90), African American race (HR 0.78 CI 0.65–0.95), and hydroxychloroquine use (HR 0.53, CI 0.41–0.67).<ref name=MountSanai/>}}

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{{A total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio [HR] 2.34, CI 1.47–3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06–1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13–1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56–2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m2 (HR 1.80, CI 1.60–2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12–2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02–1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23–1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77–0.90), African American race (HR 0.78 CI 0.65–0.95), and hydroxychloroquine use (HR 0.53, CI 0.41–0.67).<ref name=MountSanai/>}} The confidence interval for HCQ in this study ranged from .41 to .67, which indicates that HCQ was associated with decreased risk of in-hospital mortality. If we use the .53 hazard ratio, people given HCQ were 47% less likely to die. As shown by the supplementary figure four of the study, the survival of patients was significantly higher for patients taking HCQ. (P < 0.001). That is a highly significant finding and a strong indicator that HCQ works. There were no statistical results presented for HCQ among the ambulatory patients, though it was reported that the majority of them did not receive the drug.<ref name=MountSanai/>

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The confidence interval for HCQ in this study ranged from .41 to .67, which indicates that HCQ was associated with decreased risk of in-hospital mortality. If we use the .53 hazard ratio, people given HCQ were 47% less likely to die. As shown by the supplementary figure four of the study, the survival of patients was significantly higher for patients taking HCQ. (P < 0.001). That is a highly significant finding and a strong indicator that HCQ works. There were no statistical results presented for HCQ among the ambulatory patients, though it was reported that the majority of them did not receive the drug.<ref name=MountSanai/>

==Scientific studies that say hydroxychloroquine has a statistically significant net benefit==

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One of the arguments raised by individuals wishing to dismiss HCQ as a treatment option for COVID-19 is that the evidence supporting its efficacy is anecdotal. That actually isn't the case. Research studies such as the one conducted at Mount Sanai hospital have be done and statistically significant results have been achieved. That is science ''not'' anecdote. Of course, like with any scientific analysis, the conclusions could be wrong and the results need to be scrutinized (unlike what ''The Lancet'' did with Surgisphere's data). So here is a novel thought. Why don't we scrutinize the data ''logically'' instead of doing whatever Richard Horton thinks passes as empiricism?

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One of the early studies published on HCQ as a possible treatment for COVID-19 was [https://jornalggn.com.br/sites/default/files/2020/04/paper-preventsenior.pdf Empirical treatment with hydroxychloroquine and azithromycin for suspected cases of COVID-19 followed-up by telemedicine] which was published as a preprint on April 15<ref name=c19study/> by the Prevent Senior Institute in São Paulo, Brazil. The study had several limitations that made it less than ideal... it wasn't randomized and it had to assume that patients who were exhibiting flu-like symptoms during São Paulo's SARS-CoV-2 pandemic had contracted SARS-CoV-2 (testing wasn't widely available at the time), but the study also had several strengths. Unlike retrospective studies like the VA study, it had a natural control group - it offered to give HCQ and azithromycin to 636 symptomatic outpatients, 412 of whom accepted the treatment (the treatment group) and 224 of whom refused the medications (the control group). It also used HCQ ''early'' which is when antivirals are most effective and the patients were monitored by telemedicine<ref name =Brazilstud/> (unlike Boulware's study). So what where the results?

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{{Need for hospitalization was 1.9% in the treatment group and 5.4% in the control group (2.8 times greater) and number needed to treat was 28. In those who started treatment before versus after the seventh day of symptoms, the need for hospitalization was 1.17% and 3.2%, respectively. Conclusion: Empirical treatment with hydroxychloroquine associated with azithromycin for suspected cases of COVID-19 infection reduces the need for hospitalization (p< 0.001).<ref name =Brazilstud/>}}

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{{Need for hospitalization was 1.9% in the treatment group and 5.4% in the control group (2.8 times greater) and number needed to treat was 28. In those who started treatment before versus after the seventh day of symptoms, the need for hospitalization was 1.17% and 3.2%, respectively. Conclusion: Empirical treatment with hydroxychloroquine associated with azithromycin for suspected cases of COVID-19 infection reduces the need for hospitalization (p< 0.001).<ref name =Brazilstud/>}} ''That'' is a ''highly'' significant result, not "anecdote". Actually, highly significant ''results'' as the study showed two things.

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''That'' is a ''highly'' significant result, not "anecdote". Actually, highly significant ''results'' as the study showed two things.

# Need for hospitalization is substantially reduced (2.8 times less) when patients are treated with HCQ.

# Patients who are treated with HCQ before the seventh day of symptoms do significantly better than patients who receive the treatment late.

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These are potentially life-saving results in a study that was in a preprint ''before'' the VA study was in a preprint and yet ~~receives no love from~~ the mainstream media. It was also slightly larger than the VA study.

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These are potentially life-saving results in a study that was in a preprint ''before'' the VA study was in a preprint and yet is almost completely ignored by the mainstream media. It was also slightly larger than the VA study.

===Gómez Ulla in Spain===

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P=0.002 is another ''highly'' significant result with potentially life saving implications that was in a preprint after the VA study but before Surgisphere. The main disadvantage of this study was that it was small... 166 patients is not a high number.

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This study also ~~received no love from~~ the mainstream media.

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This study is also ignored by the mainstream media.

===IHU Méditerranée Infection hospital in France===

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While the study had less patients than Mount Sanai's (it had 3,737 patients), the fact that it had researchers involved throughout the process gave them a lot of data to work with and use in their analysis. For example, 2,065 low-dose CT scan characteristics were performed among the patients in order to evaluate the effect the virus was having on the lungs. They also "recorded lymphocyte, eosinophil and platelet counts; fibrinogen; D-dimer and other coagulation factors; electrolytes; zinc; lactate dehydrogenase (LDH); creatine phosphokinase (CPK); C-reactive protein; and HCQ serum dosage. Viral load was analysed by qPCR from nasopharyngeal swabs at admission and during the follow-up." The studies main problems was that it was an observational study whose control group consisted mostly of people who had risk factors for HCQ or where seen before HCQ + AZ became the hospital's go-to treatment.<ref name =Francestud/> So what did they find?

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{{The patients’ mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score = 0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed. Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia; eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase, creatinine phosphokinase, troponin and C-reactive protein) and moderate and severe lesions detected in low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11–0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27–0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17–1.42). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500 ms. No cases of torsade de pointe or sudden death were observed.</nowiki><ref name =Francestud>[https://www.sciencedirect.com/science/article/pii/S1477893920302817 Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis] by Jean-Christophe Lagier et. al. (July–August 2020) ''Travel Medicine and Infectious Disease''</ref>}}

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{{The patients’ mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score = 0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed. Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia; eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase, creatinine phosphokinase, troponin and C-reactive protein) and moderate and severe lesions detected in low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11–0.27), decreased risk of hospitalization ≥10 days (odds ratios 95% CI 0.38 0.27–0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17–1.42). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500 ms. No cases of torsade de pointe or sudden death were observed.</nowiki><ref name =Francestud>[https://www.sciencedirect.com/science/article/pii/S1477893920302817 Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis] by Jean-Christophe Lagier et. al. (July–August 2020) ''Travel Medicine and Infectious Disease''</ref>}} A case fatality rate of 0.9% is really low when compared to other studies, although the fact that patients with milder symptoms were included in the study certainly helped. For comparison, across the channel, the RECOVERY trial's case fatality rate was 25.7% for hydroxychloroquine and 23.5% for usual care.

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A case fatality rate of 0.9% is really low when compared to other studies, although the fact that patients with milder symptoms were included in the study certainly helped. For comparison, across the channel, the RECOVERY trial's case fatality rate was 25.7% for hydroxychloroquine and 23.5% for usual care.

The study also showed that HCQ was associated with a shorter duration of viral shedding, as one might expect when an antiviral is working as an antiviral. 10.6% of patients using HCQ and AZ had the virus persist longer than ten days versus 20.6% of patients using other treatments. That result had a statistical significance of P<0.001. HCQ was also associated with decreased risk of transfer to the ICU or death and decreased risk of hospitalization, both of which were statistically significant results (P<.001). The study also had zero cases of torsade de pointe despite having treated over 3000 patients. That is a critically important finding as the main argument opponents of HCQ use is that it causes torsade de pointe which can lead to sudden death. It must be noted that Raoult's numbers are helped by the fact that he screened out people who had risk factors for HCQ and QTc prolongation was monitored through EKGs in hospitalized patients.<ref name =Francestud/><ref name =CMRaoult>[https://www.youtube.com/watch?v=1MAoJnu7-sw&list=PLRgTUN1zz_oeQpnJxpeaEkFimDeepqyWf&t=1670 Covid-19: Is The Worst Behind Us?] by Dr. Chris Martenson (Jun 25, 2020) ''PeakPosperity''</ref>

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*[https://www.msn.com/en-us/health/medical/french-doctor-defiant-on-hydroxychloroquine-despite-study/ar-BB14zBoY '''French doctor defiant on hydroxychloroquine despite study - MSN''']

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{{cquote|Raoult, a distinctive figure with his shoulder-length shaggy grey hair, ended the video by repeating another controversial claim that "this is the end of the epidemic". Looking at the records of 96,000 patients across hundreds of hospitals, the study published in ''The Lancet'' found that administering the drugs actually increased the risk of dying.<ref>[https://www.msn.com/en-us/health/medical/french-doctor-defiant-on-hydroxychloroquine-despite-study/ar-BB14zBoY French doctor defiant on hydroxychloroquine despite study] (5/25/2020) ''AFP'' and ''MSN''</ref>}} The study Dr. Raoult was defiant of was Surgisphere's...

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{{cquote|Raoult, a distinctive figure with his shoulder-length shaggy grey hair, ended the video by repeating another controversial claim that "this is the end of the epidemic". Looking at the records of 96,000 patients across hundreds of hospitals, the study published in ''The Lancet'' found that administering the drugs actually increased the risk of dying.<ref>[https://www.msn.com/en-us/health/medical/french-doctor-defiant-on-hydroxychloroquine-despite-study/ar-BB14zBoY French doctor defiant on hydroxychloroquine despite study] (5/25/2020) ''AFP'' and ''MSN''</ref>}}

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The study Dr. Raoult was defiant of was Surgisphere's...

* [https://slate.com/news-and-politics/2020/03/didier-raoult-hydroxychloroquine-plaquenil.html '''The Trumpian French Doctor Behind the Chloroquine Hype - The source of the hopes for a coronavirus cure should raise a lot of red flags - Slate''']

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The title says it all. There are some legitimate concerns contained within the article such as the research not being a double-blind placebo controlled trial, but the coverage was hardly balanced. For example, it failed to mention that the drug chloroquine was shown to have efficacy against SARS CoV before Dr. Raoult promoted HCQ as a cure.<ref>[https://slate.com/news-and-politics/2020/03/didier-raoult-hydroxychloroquine-plaquenil.html The Trumpian French Doctor Behind the Chloroquine Hype - The source of the hopes for a coronavirus cure should raise a lot of red flags.] by Robert Zaretsky (March 30, 2020) ''Slate''</ref>

* [https://www.forbes.com/sites/alexledsom/2020/07/19/hydroxychloroquine-europe-turns-away-from-doctor-who-championed-drug-with-irresponsible-study/ '''Hydroxychloroquine: Europe Turns Away From Doctor Who Championed Drug With ‘Irresponsible’ Study - Forbes''']

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{{cquote|The results from two new drug trials have failed to find evidence that hydroxychloroquine works to treat Covid-19... One was the RECOVERY trial, supported by a grant to the University of Oxford in the U.K. The other was from researchers at the University of Minnesota.<ref name =Forbes>[https://www.forbes.com/sites/alexledsom/2020/07/19/hydroxychloroquine-europe-turns-away-from-doctor-who-championed-drug-with-irresponsible-study/ Hydroxychloroquine: Europe Turns Away From Doctor Who Championed Drug With ‘Irresponsible’ Study] by Alex Ledsom (Jul 19, 2020) ''Forbes''</ref>}} So a ''travel writer'' is arguing that the doctors in the RECOVERY trial who prescribed three times the maximum recommended dose for HCQ and had a 25.7% case fatality rate are the ones being responsible and the doctors whom ceased treatment in 12 patients with QTc prolongation and had a 0.9% case fatality rate are the ones being irresponsible? Interesting. As for the Minnesota study she mentioned, the author failed to state that Boulware believed day 1-3 HCQ use had enough statistical significance to warrant further investigation. She also defended Surgisphere ''after'' their study had been retracted, citing the company's claim that the release of their data would violate third party client confidentiality agreements.

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{{cquote|The results from two new drug trials have failed to find evidence that hydroxychloroquine works to treat Covid-19... One was the RECOVERY trial, supported by a grant to the University of Oxford in the U.K. The other was from researchers at the University of Minnesota.<ref name =Forbes>[https://www.forbes.com/sites/alexledsom/2020/07/19/hydroxychloroquine-europe-turns-away-from-doctor-who-championed-drug-with-irresponsible-study/ Hydroxychloroquine: Europe Turns Away From Doctor Who Championed Drug With ‘Irresponsible’ Study] by Alex Ledsom (Jul 19, 2020) ''Forbes''</ref>}}

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So a ''travel writer'' is arguing that the doctors in the RECOVERY trial who prescribed three times the maximum recommended dose for HCQ and had a 25.7% case fatality rate are the ones being responsible and the doctors whom ceased treatment in 12 patients with QTc prolongation and had a 0.9% case fatality rate are the ones being irresponsible? Interesting. As for the Minnesota study she mentioned, the author failed to state that Boulware believed day 1-3 HCQ use had enough statistical significance to warrant further investigation. She also defended Surgisphere ''after'' their study had been retracted, citing the company's claim that the release of their data would violate third party client confidentiality agreements.

===USA===

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Before Dr. Immanuel's video went viral, the medical professional most prominently associated with HCQ in the United States was Dr. Vladimir Zelenko, a general practitioner who treats patients in the state of New York. Since the time he first told [[Rudy Giuliani]] about [https://www.youtube.com/watch?v=1TJdjhd_XG8 the positive results he was having with HCQ + AZ + zinc], he has coauthored a preprint entitled [https://www.preprints.org/manuscript/202007.0025/v1 COVID-19 outpatients – early risk-stratified treatment with zinc plus low dose hydroxychloroquine and azithromycin: a retrospective case series study]. The study has some problems in its current form, the most glaring of which is that "only outcome data for hospitalization and all cause death was available" for the untreated control group.<ref name =Zalenkostud>[https://www.preprints.org/manuscript/202007.0025/v1 COVID-19 outpatients – early risk-stratified treatment with zinc plus low dose hydroxychloroquine and azithromycin: a retrospective case series study] by Martin Scholz, Roland Derwand, and Vladimir Zelenko (3 July 2020) 2020070025</ref> Ideally, one would wish to use propensity matching with these results, with age being one of the factors being accounted for, but that simply isn't possible with the data the researchers had available to them. This having been said, the study is notable due to its incorporation of zinc, its study of outpatients, and Dr. Zelenko's prominence in the media. So what were the results?

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{{In the treatment group 4 of 141 patients were hospitalized, which was significantly less than in the untreated group with 58 of 377 patients (15.4%), (fig 2.), (OR 0.16; [95% CI, 0.06 to 0.5]; p<0.001), (table 7, fig 4). Therefore, the odds of hospitalization of treated patients were 84% less than in the untreated patients... One of the 141 patients (0.71%) who belonged to treatment group A (age > 60 years) died after being hospitalized. This patient had a history of cancer and did only take one daily dose of the triple therapy before hospital admission. With 13 of 377 patients (3.5%, fig 3) more patients died in the untreated group (OR 0.2; [95% CI, 0.03 to 1.5]) (table 7, fig 4). The odds of all-cause death of treated patients were 80% less <nowiki>(p=0.16)</nowiki> than in the untreated group.<ref name =Zalenkostud/>}}

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{{In the treatment group 4 of 141 patients were hospitalized, which was significantly less than in the untreated group with 58 of 377 patients (15.4%), (fig 2.), (OR 0.16; [95% CI, 0.06 to 0.5]; p<0.001), (table 7, fig 4). Therefore, the odds of hospitalization of treated patients were 84% less than in the untreated patients... One of the 141 patients (0.71%) who belonged to treatment group A (age > 60 years) died after being hospitalized. This patient had a history of cancer and did only take one daily dose of the triple therapy before hospital admission. With 13 of 377 patients (3.5%, fig 3) more patients died in the untreated group (OR 0.2; [95% CI, 0.03 to 1.5]) (table 7, fig 4). The odds of all-cause death of treated patients were 80% less <nowiki>(p=0.16)</nowiki> than in the untreated group.<ref name =Zalenkostud/>}} It is a small study with serious questions concerning its control group, but Dr. Zelenko was able to find a statistically significant reduction in the hospitalization rate of patients treated with HCQ.

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It is a small study with serious questions concerning its control group, but Dr. Zelenko was able to find a statistically significant reduction in the hospitalization rate of patients treated with HCQ.

Dr. Zelenko is another figure who is too prominent to be ignored.

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When SARS-CoV-2 hit Detroit, the Henry Ford Health System set up a COVID-19 task force and established ''uniform treatments'' across all of its 6 hospitals in order to assess what their treatment protocol should be. The "patient population received aggressive early medical intervention", which means that treatments were given early, and the treatment of hydroxychloroquine + azithromycin was reserved "for selected patients ''with severe COVID-19'' with ''minimal cardiac risk factors''." The fact that hospitalized patients were studied means that the study is closer to Mount Saini's study than it is with Brazil's study of outpatients.<ref name =Fordstud>[https://www.ijidonline.com/action/showPdf?pii=S1201-9712%2820%2930534-8 Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19] by Samia Arshad et. al. (29 June 2020) ''International Journal of Infectious Diseases''</ref><ref name =CMFord>[https://www.youtube.com/watch?v=1plkwhi5KUE&list=PLRgTUN1zz_oeQpnJxpeaEkFimDeepqyWf&t=720 Covid-19: Vindication! HCQ+ & Ivermectin Work!] Dr. Chris Martenson (Jul 7, 2020) ''PeakProsperity''</ref> Before we get to the results, the study also mentioned why HCQ + AZ was chosen as a potential treatment option. Given the political controversy surrounding HCQ, what they had to say is particularly important.

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{{quotebox|Hydroxychloroquine, an antimalarial and immunomodulatory agent and a safer analogue of chloroquine, has demonstrated antiviral activity against SARS-CoV-2 (Wang et al., 2020a; Liu et al., 2020; Yao et al., 2020; WHO, 2017). It is postulated to exert a direct antiviral activity by increasing intracellular pH resulting in decreased phago-lysosome fusion, impairing viral receptor glycosylation. In addition, it has immune-modulating effect by inhibiting toll-like receptor signaling, decreasing production of cytokines especially IL-1 and IL-6 (Savarino et al., 2003). Prior data also suggests a potential anti-thrombotic effect (Jung et al., 2010). Azithromycin, a macrolide antibiotic, has in vitro antiviral properties such as decreased viral replication, blocking entrance into host cells, and a potential immunomodulating effect (Tran et al., 2019). An in vitro study demonstrated synergistic activity of the combination of hydroxychloroquine and azithromycin against SARS-CoV-2 (Andreani et al., 2020). A small non-randomized, open-label trial from France reported higher frequency of SARSCoV-2 clearance after six days of treatment with hydroxychloroquine alone or hydroxychloroquine in combination with azithromycin versus untreated control group (70% vs 12.5%; P<0.001) (Gautret et al., 2020a)<ref name =Fordstud/>}}

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{{quotebox|Hydroxychloroquine, an antimalarial and immunomodulatory agent and a safer analogue of chloroquine, has demonstrated antiviral activity against SARS-CoV-2 (Wang et al., 2020a; Liu et al., 2020; Yao et al., 2020; WHO, 2017). It is postulated to exert a direct antiviral activity by increasing intracellular pH resulting in decreased phago-lysosome fusion, impairing viral receptor glycosylation. In addition, it has immune-modulating effect by inhibiting toll-like receptor signaling, decreasing production of cytokines especially IL-1 and IL-6 (Savarino et al., 2003). Prior data also suggests a potential anti-thrombotic effect (Jung et al., 2010). Azithromycin, a macrolide antibiotic, has in vitro antiviral properties such as decreased viral replication, blocking entrance into host cells, and a potential immunomodulating effect (Tran et al., 2019). An in vitro study demonstrated synergistic activity of the combination of hydroxychloroquine and azithromycin against SARS-CoV-2 (Andreani et al., 2020). A small non-randomized, open-label trial from France reported higher frequency of SARSCoV-2 clearance after six days of treatment with hydroxychloroquine alone or hydroxychloroquine in combination with azithromycin versus untreated control group (70% vs 12.5%; P<0.001) (Gautret et al., 2020a)<ref name =Fordstud/>}} There is no mentioning of [[Donald Trump]] or [[Rudy Giuliani]]. Or patients with lupus and rheumatoid arthritis struggling to get HCQ. Or COVID-19 patients self-medicating with fish-tank cleaner. Or Surgisphere. And if you didn't know who Andreani and Gautret worked for, no mentioning of Dr. Didier Raoult. All they cared about was the science.

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There is no mentioning of [[Donald Trump]] or [[Rudy Giuliani]]. Or patients with lupus and rheumatoid arthritis struggling to get HCQ. Or COVID-19 patients self-medicating with fish-tank cleaner. Or Surgisphere. And if you didn't know who Andreani and Gautret worked for, no mentioning of Dr. Didier Raoult. All they cared about was the science.

Without further ado, here are the results.

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{{quotebox|Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4–10 days), median age was 64 years (IQR:53–76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3–53). Overall in-hospital mortality was 18.1% (95% CI:16.6%–19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%–23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%–15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%–30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%–31.0%]). Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9–3.3]), white race (HR:1.7 [95% CI:1.4–2.1]), CKD (HR:1.7 [95%CI:1.4–2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1–2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4–3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p <0.001).<ref name =Fordstud/>}}

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{{quotebox|Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4–10 days), median age was 64 years (IQR:53–76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3–53). Overall in-hospital mortality was 18.1% (95% CI:16.6%–19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%–23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%–15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%–30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%–31.0%]). Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9–3.3]), white race (HR:1.7 [95% CI:1.4–2.1]), CKD (HR:1.7 [95%CI:1.4–2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1–2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4–3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p <0.001).<ref name =Fordstud/>}} In other words, HCQ cut the death rate by over half.

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In other words, HCQ cut the death rate by over half.

This study is not without its own problems. It is similar to Dr. Raoult's study in that the control group consisted mostly of people with risk factors for HCQ and it is an observational study.

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It worked. (They also found PPE worked.)

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{{Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2.</nowiki><ref name=Indiastud>[https://pubmed.ncbi.nlm.nih.gov/32611916/ Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19] by Pranab Chatterjee (2020 May) ''The Indian Journal of Medical Research''</ref>}}

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{{Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2.</nowiki><ref name=Indiastud>[https://pubmed.ncbi.nlm.nih.gov/32611916/ Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19] by Pranab Chatterjee (2020 May) ''The Indian Journal of Medical Research''</ref>}} AOR stands for adjusted odds ratio and it represents how likely a certain outcome will occur given exposure to the variable of interest. In this case, the outcome is SARS-CoV-2 infected and the variable of interest is the use of HCQ. Odds ratios above 1 mean that that outcome is more likely to occur given exposure to the variable. In the above results, "Performing endotracheal intubation" was associated with a high likelihood of being SARS-CoV-2 infected (4.33). Odds rations that are below 1 mean that the outcome is less likely to occur. In the above results, "4 or more maintenance doses of HCQ" was associated with a significant decline in the odds of health care workers becoming SARS-Cov-2 infected (0.44). This means that people who took HCQ were about half as likely to become infected than those who didn't take the drug (the confidence interval ranged from .22 to .88). India's researchers also found that HCQ's dose-response relationship had statistical significance (P <0.001).<ref name=Indiastud/><ref name=CBoul/>

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AOR stands for adjusted odds ratio and it represents how likely a certain outcome will occur given exposure to the variable of interest. In this case, the outcome is SARS-CoV-2 infected and the variable of interest is the use of HCQ. Odds ratios above 1 mean that that outcome is more likely to occur given exposure to the variable. In the above results, "Performing endotracheal intubation" was associated with a high likelihood of being SARS-CoV-2 infected (4.33). Odds rations that are below 1 mean that the outcome is less likely to occur. In the above results, "4 or more maintenance doses of HCQ" was associated with a significant decline in the odds of health care workers becoming SARS-Cov-2 infected (0.44). This means that people who took HCQ were about half as likely to become infected than those who didn't take the drug (the confidence interval ranged from .22 to .88). India's researchers also found that HCQ's dose-response relationship had statistical significance (P <0.001).<ref name=Indiastud/><ref name=CBoul/>

===Other Studies===

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The clinical name for sudden death caused by excessive lengthening of the QT interval is {{wpl|Torsades de pointes}} and it is monitored through EKGs. Some people have long QT intervals due to genetic factors, but QT elongation can also be acquired through medications.<ref>[https://www.mayoclinic.org/diseases-conditions/long-qt-syndrome/symptoms-causes/syc-20352518 Long QT syndrome] by Mayo Clinic Staff (accessed 7-31-2020) ''Mayo Clinic''</ref> There are several medications that have this effect, including Abarelix, Aclarubicin, Alfuzosin, Alimemazine, Amiodarone, Anagrelide, Apalutamide, Apomorphine, Aripiprazole, Arsenic trioxide, Artemether, Artenimol, Asenapine, Astemizole, Atomoxetine, and Azithromycin (and those are just the A's).<ref>[https://crediblemeds.org/index.php/new-drug-list Risk Categories for Drugs that Prolong QT & induce Torsades de Pointes (TdP)] (May 12, 2020) ''CredibleMeds.org''</ref>. Because of the concern of torsades de pointe, people taking these medications in a hospital setting will be monitored and the course of their medication may be altered due to perceived risk. The following is how the Henry Ford study described their procedure.

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{{An electrocardiogram (ECK) based algorithm was utilized for hydroxychloroquine use. QTc>500 ms was considered an elevated cardiac risk and consequently hydroxychloroquine was reserved for patients with severe disease with telemetry monitoring and serial QTc checks.<ref name =Fordstud/>}}

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{{An electrocardiogram (ECK) based algorithm was utilized for hydroxychloroquine use. QTc>500 ms was considered an elevated cardiac risk and consequently hydroxychloroquine was reserved for patients with severe disease with telemetry monitoring and serial QTc checks.<ref name =Fordstud/>}} People with naturally long QT intervals or other cardiac risk factors may also be excluded from the use of drugs that prolong QT due to the risk of torsades de pointes.

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People with naturally long QT intervals or other cardiac risk factors may also be excluded from the use of drugs that prolong QT due to the risk of torsades de pointes.

The largest study to monitor cardiac risk in regards to COVID-19 and HCQ use was the one conducted by Didier Raoult's team where 3,119 patients were treated with HCQ and AZ. Of those patients, QT prolongation was only observed in 25 of them (0.67%) and this led to cessation of treatment in 12 of the cases. There were ''zero'' cases of torsades de pointes.<ref name =Francestud/> The Henry Ford Health System study was somewhat smaller (1985 patients treated with HCQ) and they reserved the HCQ + AZ treatment to people with minimal cardiac risk factors. They also had zero cases of torsades de pointes.<ref name =Fordstud/> Thus, the likelihood of HCQ-induced torsades de pointes in two large studies was zero, with the caveat that the researchers screened out patients with HCQ risk factors and used EKGs to monitor their patients for risk.

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As HCQ is commonly used in outpatient settings for diseases such as malaria, the likelihood of sudden death from its use has already been addressed. A massive study entitled [https://www.who.int/malaria/mpac/mpac-mar2017-erg-cardiotoxicity-report-session2.pdf The cardiotoxicity of antimalarials] was conducted by the WHO in 2016 and found the following:

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{{cquote|"Apart from halofantrine, the oral antimalarial drugs, particularly chloroquine and piperaquine, have been used extensively with very few reports of cardiotoxicity...Despite hundreds of millions of doses administered in the treatment of malaria, ''there have been no reports of sudden unexplained death'' associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation."<ref name=WHOHCQ/><ref name=CMside/>}}

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{{cquote|"Apart from halofantrine, the oral antimalarial drugs, particularly chloroquine and piperaquine, have been used extensively with very few reports of cardiotoxicity...Despite hundreds of millions of doses administered in the treatment of malaria, ''there have been no reports of sudden unexplained death'' associated with quinine, chloroquine or amodiaquine, although each drug causes QT/QTc interval prolongation."<ref name=WHOHCQ/><ref name=CMside/>}} So out of hundreds of millions of doses being administered, the likelihood of sudden death is zero? Well not quite zero as shown by [https://pubmed.ncbi.nlm.nih.gov/16615675/ this case report, although that person didn't die due to medical intervention]. But the risk is still ''really'' low, particularly when compared to the risk associated with being harmed by SARS-CoV-2 (or malaria, for that matter). If one has risk factors such as a naturally long QT interval, HCQ may still pose some risk, which is probably why it is not an over-the-counter medication. But if one is healthy, it is difficult to beat HCQ's safety profile. Just don't expect to hear that from the mainstream media as they are in the business of promoting a false narrative.

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So out of hundreds of millions of doses being administered, the likelihood of sudden death is zero? Well not quite zero as shown by [https://pubmed.ncbi.nlm.nih.gov/16615675/ this case report, although that person didn't die due to medical intervention]. But the risk is still ''really'' low, particularly when compared to the risk associated with being harmed by SARS-CoV-2 (or malaria, for that matter). If one has risk factors such as a naturally long QT interval, HCQ may still pose some risk, which is probably why it is not an over-the-counter medication. But if one is healthy, it is difficult to beat HCQ's safety profile. Just don't expect to hear that from the mainstream media as they are in the business of promoting a false narrative.

==Motivated reasoning among the mainstream media?==

===AP===

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{{cquote|British researchers on Friday published their research on the only drug shown to improve survival — a cheap steroid called dexamethasone. Two other studies found that the malaria drug hydroxychloroquine does not help people with only mild symptoms... the only other therapy that’s been shown to help COVID-19 patients is remdesivir, an antiviral that shortens hospitalization by about four days on average.<ref name= APMar>[https://apnews.com/336858902a2f21759da446b966ec1c11 New studies clarify what drugs help, hurt for COVID-19] by Marilynn Marchionne (July 17, 2020) ''AP NEWS''</ref>}}

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{{cquote|British researchers on Friday published their research on the only drug shown to improve survival — a cheap steroid called dexamethasone. Two other studies found that the malaria drug hydroxychloroquine does not help people with only mild symptoms... the only other therapy that’s been shown to help COVID-19 patients is remdesivir, an antiviral that shortens hospitalization by about four days on average.<ref name= APMar>[https://apnews.com/336858902a2f21759da446b966ec1c11 New studies clarify what drugs help, hurt for COVID-19] by Marilynn Marchionne (July 17, 2020) ''AP NEWS''</ref>}} The above quote was taken from [https://twitter.com/MMarchioneAP Marilynn Marchionne's] ''New studies clarify what drugs help, hurt for COVID-19'', an article rife with errors.

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The above quote was taken from [https://twitter.com/MMarchioneAP Marilynn Marchionne's] ''New studies clarify what drugs help, hurt for COVID-19'', an article rife with errors.

'''Error/Claim #1 - Dexamethasone is the only drug shown to improve survival.'''

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That's not true. All drugs which have studies that have statistically significant correlations (p<.05) linking their use to increased survival are drugs "shown to improve survival" and HCQ has a lot of those studies. Granted, one can take issue with the results and argue that there are reasons not to believe them (like with Surgisphere, for example), but the onus of proof is on the person seeking to refute the studies. You can't just ignore the fact that the studies exist.

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In addition to HCQ, there are other drugs the author failed to mention that have shown to improve survival.

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'''Error/Claim #2 - Two other studies found that the malaria drug hydroxychloroquine does not help people with only mild symptoms.'''

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The two studies referenced were [https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa1009/5872589?searchresult=1 a small study from Spain] and the Minnesota study Boulware co-authored. Like the Minnesota study, the Spain study had positive results that supported HCQ use but it failed to reach statistical significance, likely due to its small sample size (it only had 293 people which is much smaller than the 6000 people the Minnesota study said were needed to reach statistical significance).<ref>[https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa1009/5872589 Hydroxychloroquine for Early Treatment of Adults with Mild Covid-19: A Randomized-Controlled Trial] by Oriol Mitjà (16 July 2020) ''Clinical Infectious Diseases''</ref> The fact that these were the two studies chosen as evidence "against" HCQ is a clear-cut case of cherry picking. The fact that studies with statistically significant positive results such as the ones conducted at Prevent Senior Institute in Brazil, Gómez Ulla in Spain, IHU Méditerranée Infection in France, the Henry Ford and Mount Sanai hospitals in the USA, and by the ICMR COVID-19 Research Team in India were not mentioned in the article are fallacies of omission.

'''Error/Claim #3 - The only other ''therapy'' that’s been shown to help COVID-19 patients is remdesivir.'''

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What about the plasma therapy that was covered on ''60 minutes'' and analyzed [https://pubmed.ncbi.nlm.nih.gov/32253318/ in this study?]<ref>[https://www.cbsnews.com/video/coronavirus-antibodies-blood-plasma-therapy-60-minutes-2020-05-31/ Inside the plasma therapy doctors are using to treat COVID-19] by Bill Whitiker (May 31, 2020) ''60 Minutes''</ref><ref>[https://pubmed.ncbi.nlm.nih.gov/32253318/ Effectiveness of convalescent plasma therapy in severe COVID-19 patients] by Kai Duan (2020 Apr 6) ''Proceedings of the National Academy of Sciences of the USA''</ref> (Actually, the study is really small and other studies have shown that plasma therapy doesn't work late in the disease progression, but if the criterion of proof is "as good as or better than remdesivir," then it has been shown to help.)

'''Error/Claim #4 - HCQ is harmful'''

−

The article goes on to report "Now, details published on a research site for scientists show that the drug may have done harm. Patients given hydroxychloroquine were less likely to leave the hospital alive within 28 days — 60 percent on the drug versus 63 percent given usual care."<ref name= APMar/>

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If it was just Marilynn Marchione shading the truth, then other independent journalists could correct the misinformation by pointing out the flaws in the argument and provide the public with strong, fact-based, counter-arguments. Unfortunately, [https://twitter.com/MMarchioneAP Marilynn Marchione's] reporting style is par for the course. Another example is ''Coronavirus: Dexamethasone proves first life-saving drug'', written by Michelle Roberts, which says the following:

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{{cquote|The Recovery Trial, running since March, also looked at the malaria drug hydroxychloroquine, which has subsequently been ditched amid concerns it increases fatalities and heart problems. The antiviral drug remdesivir, meanwhile, which appears to shorten recovery time for people with coronavirus, is already being made available on the NHS.<ref name =BBC/>}}

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{{cquote|The Recovery Trial, running since March, also looked at the malaria drug hydroxychloroquine, which has subsequently been ditched amid concerns it increases fatalities and heart problems. The antiviral drug remdesivir, meanwhile, which appears to shorten recovery time for people with coronavirus, is already being made available on the NHS.<ref name =BBC/>}} There is no reason for the antiviral drugs remdesivir and HCQ to be mentioned in an article about the steroid dexamethasone unless one was trying to make a comprehensive analysis of the medical literature, which this article wasn't doing. If one wanted to add context, then the author could have instead talked about the closely related drug methylprednasone and the MATH+ protocol. And, in order to inform the reader, one could explain that the MATH+ protocol has a 6.6% mortality rate in one hospital and a 3.3% mortality rate in another<ref name=MATH/> whereas the RECOVERY trial is rocking a 41% mortality rate among patients on a ventilator, 25% mortality rate among those on oxygen therapy, and a 13% mortality rate on those patients who did not require respiratory intervention.<ref name=Recovery2/>

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There is no reason for the antiviral drugs remdesivir and HCQ to be mentioned in an article about the steroid dexamethasone unless one was trying to make a comprehensive analysis of the medical literature, which this article wasn't doing. If one wanted to add context, then the author could have instead talked about the closely related drug methylprednasone and the MATH+ protocol. And, in order to inform the reader, one could explain that the MATH+ protocol has a 6.6% mortality rate in one hospital and a 3.3% mortality rate in another<ref name=MATH/> whereas the RECOVERY trial is rocking a 41% mortality rate among patients on a ventilator, 25% mortality rate among those on oxygen therapy, and a 13% mortality rate on those patients who did not require respiratory intervention.<ref name=Recovery2/>

==="The Worldwide Leader in News"===

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"Among a number of limitations, this study included patients who were initiated on hydroxychloroquine therapy at any time during their hospitalization... Because treatment regimens likely varied substantially (including delayed initiation) across the 25 hospitals that contributed patients to the study, it is not surprising that the case-fatality rate among the New York patients was significantly higher than in our (the Henry Ford) study.<ref name =Fordstud/>"

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As of August 1, 2020, CNN's coverage of the VA study also made no attempt at "balance".<ref>[ https://www.cnn.com/2020/04/21/health/hydroxychloroquine-veterans-study/index.html] by Elizabeth Cohen and Dr. Minali Nigam (9:46 PM ET, Tue April 21, 2020) ''CNN''</ref> Heck, they didn't even bother to update their article on Surgisphere's study even though ''The Lancet'' had retracted it.<ref name=CNNSurg/>

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As of August 1, 2020, CNN's coverage of the VA study also made no attempt at "balance".<ref>[https://www.cnn.com/2020/04/21/health/hydroxychloroquine-veterans-study/index.html] by Elizabeth Cohen and Dr. Minali Nigam (9:46 PM ET, Tue April 21, 2020) ''CNN''</ref> Heck, they didn't even bother to update their article on Surgisphere's study even though ''The Lancet'' had retracted it.<ref name=CNNSurg/>

===The media truly hates HCQ===

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On July 28, 2020, Dr. Stella Immanuel promoted HCQ in a video that went viral, but what is more telling than her belief in the virtues of ~~HCQ~~ was the social and news media's response to it.

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On July 28, 2020, Dr. Stella Immanuel promoted HCQ in a video that went viral, but what is more telling than her belief in the virtues of the drug was the social and news media's response to it.

*Twitter banned Donald Trump Jr.'s account for his posting of the video and deleted Donald Trump's retweet of it.<ref name=Federalist>[https://thefederalist.com/2020/07/28/donald-trump-jr-suspended-from-twitter-over-video-promoting-hydroxychloroquine/ Donald Trump Jr. Suspended From Twitter Over Video Promoting Hydroxychloroquine] by Jordan Davidson (JULY 28, 2020) ''The Federalist''</ref>

*Facebook took the video down “for sharing false information about cures and treatments for COVID-19.”<ref name=Federalist/>

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[https://www.dailymotion.com/video/x7v96lo You could still see the video at Daily Motion... but then it was taken down.]

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Several news networks also contributed to the onslaught (just google Dr. Immanuel), including NBC Nightly News which incorporated ad hominem attacks against Dr. Immanuel and America's Frontline Doctors rather than any in-depth analysis of the science (apparently Dr. Anthony Fauci's medical opinion is the only one that matters). The title of the news's segment was "Trump under fire for sharing coronavirus misinformation on social media,"<ref name=NBC>[https://news.yahoo.com/trump-under-fire-sharing-coronavirus-225556651.html Trump under fire for sharing coronavirus misinformation on social media] by Peter Alexander (July 28, 2020, 4:55 PM) ''NBC Nightly News''</ref> which leads one to ask "What misinformation?" She didn't talk about demons or the other ~~stories that~~ the media has dredged up in order to demonize her. Instead the essence of what she said was that she believed HCQ works based off of the results she was seeing with her patients and her staff. How does saying that warrant the extreme measures taken by both the social media giants and the news networks? It is not a crazy idea to believe that HCQ works when it has multiple scientific studies that support this conclusion, and yet Dr. Immanuel deserves to be portrayed as a lunatic for stating that belief? One must ask oneself why? Why has the media done this to a woman whose only crime appears to be believing in a drug that Donald Trump also happens to believe in?

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Several news networks also contributed to the onslaught (just google Dr. Immanuel), including NBC Nightly News which incorporated ad hominem attacks against Dr. Immanuel and America's Frontline Doctors rather than any in-depth analysis of the science (apparently Dr. Anthony Fauci's medical opinion is the only one that matters). The title of the news's segment was "Trump under fire for sharing coronavirus misinformation on social media,"<ref name=NBC>[https://news.yahoo.com/trump-under-fire-sharing-coronavirus-225556651.html Trump under fire for sharing coronavirus misinformation on social media] by Peter Alexander (July 28, 2020, 4:55 PM) ''NBC Nightly News''</ref> which leads one to ask "What misinformation?" She didn't talk about demons or the other ideologies the media has dredged up in order to demonize her. Instead the essence of what she said was that she believed HCQ works based off of the results she was seeing with her patients and her staff. How does saying that warrant the extreme measures taken by both the social media giants and the news networks? It is not a crazy idea to believe that HCQ works when it has multiple scientific studies that support this conclusion, and yet Dr. Immanuel deserves to be portrayed as a lunatic for stating that belief? One must ask oneself why? Why has the media done this to a woman whose only crime appears to be believing in a drug that Donald Trump also happens to believe in?

[https://twitter.com/JamesTodaroMD/ Dr. James Todaro], a popular twitter user who was involved in exposing the Surgisphere article to be a fraud, also happens to be one of the America's Frontline Doctors featured in the video. He provided a link of the video that, as of August 1, [https://vimeo.com/442781232 was still up on Vimeo].<ref name=Todaro>[https://twitter.com/JamesTodaroMD/ James Todaro's twitter account] by James Todaro (July 28,2020) ''Twitter''</ref>

==The future of HCQ==

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In her viral video, Dr. Immanuel reported seeing patients from far away because their local doctors were too afraid to prescribe the drug and being reported to the medical review board, a threat Dr. Immanuel also received.<ref>[https://vimeo.com/442781232 America's Frontline Doctors] (July 29, 2020) ''Vimeo''</ref> Yale's Epidemiology Professor Dr. Harvey Risch reported the same thing on Fox News.<ref>[https://www.foxnews.com/transcript/dr-harvey-risch-on-the-war-against-hydroxychloroquine Dr. Harvey Risch on the war against hydroxychloroquine] by Laura Ingraham (July 20, 2020) ''Fox News''</ref> This represents a public health concern and is a violation of patient rights.

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In her viral video, Dr. Immanuel reported seeing patients from far away because their local doctors were too afraid to prescribe the drug and being reported to the medical review board, a threat Dr. Immanuel also received.<ref>[https://vimeo.com/442781232 America's Frontline Doctors] (July 29, 2020) ''Vimeo''</ref> Yale's Epidemiology Professor Dr. Harvey Risch reported the same thing on Fox News.<ref>[https://www.foxnews.com/transcript/dr-harvey-risch-on-the-war-against-hydroxychloroquine Dr. Harvey Risch on the war against hydroxychloroquine] by Laura Ingraham (July 20, 2020) ''Fox News''</ref> This represents a public health concern and is arguably a violation of patient rights.

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On July 29, the state of Ohio officially banned pharmacies from fulfilling HCQ prescriptions to patients with COVID-19. Dr. James Todaro reported that this was "a direct infringement on the patient-doctor relationship." Ohio governor Mike DeWine reversed the decision at 9:30 A. M. on July 30, presumably due to public outrage.<ref name=Todaro/> Dr. Todaro subsequently had "a great meeting with Vice President Mike Pence and his Chief of Staff. We are doing everything to restore the power of medicine back to doctors. Doctors everywhere should be able to prescribe Hydroxychloroquine without repercussions or obstruction."

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On July 29, the state of Ohio officially banned pharmacies from fulfilling HCQ prescriptions to patients ~~for~~ COVID-19. Dr. James Todaro reported that this was "a direct infringement on the patient-doctor relationship." Ohio governor Mike DeWine reversed the decision at 9:30 A. M. on July 30, presumably due to public outrage.<ref name=Todaro/> Dr. Todaro subsequently had "a great meeting with Vice President Mike Pence and his Chief of Staff. We are doing everything to restore the power of medicine back to doctors. Doctors everywhere should be able to prescribe Hydroxychloroquine without repercussions or obstruction."

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Anyone in the USA reading this should be concerned about these developments. Patients should be allowed to choose for themselves whether or not HCQ's benefit outweighs the risk and there are people who are actively trying to take away that right and impose their will, irrespective of how well-informed the patient's choices may be.

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==External links==

AndyChristianson

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