As an actual pharmacologist I find it fascinating how the general public has suddenly taken such a poorly informed interest in drug discovery.
For the HN audience it would be like people taking an almost tribal approach to go-lang vs rust, debating it on national television, without any of them knowing what a loop is.
Tell me if I'm wrong, but low quality papers get published all the time, in all domains. But nobody cares about Rust vs Go in the current crisis.
Then the media take results at face value because they're constantly looking for breaking news, they give a platform to people with strong opinions rather than nuanced ones (good scientists probably don't have time for that anyway). It seems only logical that the general population has a misguided and emotional interest in the topic, especially when it has disrupted the life of so many.
I don't blame people for taking an interest, it's the tribalism of it that I find so weird and fascinating, I'd be concerned if in the future, drug-discovery efforts for things other than coronavirus get so political and emotional to people.
Yes, low quality papers indicating that existing drug X may be effective in disease Y get published all the time, probably several a day. Fortunately most of these are left to pad academic's CVs and don't really influence the pharmaceutical industry.
_Wintermute says>"Yes, low quality papers indicating that existing drug X may be effective in disease Y get published all the time, probably several a day. Fortunately most of these are left to pad academic's CVs and don't really influence the pharmaceutical industry."<
My mother-in-law is an architect by training but she was convinced (by youtube) that she ought to have some HCQ so she had family members ship us some. She's even suggested out of the blue that she should start taking it as a preventative for no particular except that she read amazon workers have been contracting covid and we get a lot of amazon packages.
When we told her that's not a good idea she felt compelled to defend HCQ against the mainstream media slander, as if that were the problem here.
The cries if mainstream media are so weird, because what even is mainstream any more? I wish such a thing still existed really. Yet one gets accused of being naively trusting of this extinct thing any time one is rational.
I don't think mainstream media is anywhere near extinct, but instead it's evolving and growing. I would argue that all the people who jumped on the HCQ bandwagon without sufficient evidence were also victims of mainstream media!
The real epidemic is the deficit of critical thinking among those who primarily look for media content to fit what they want to hear, and then close themselves off to any other input, evidence, or scrutiny.
I think the MSM weighing in and taking a position was exactly the problem. The question of HCQ efficacy would have been solved much faster without it being politicized..
The actual story of HCQ is pretty boring. It was a plausible treatment with a mixed bag of weak evidence for and against efficacy. It is not particularly dangerous.
Trump oversold and lied about the benefits. The MSM lied about the data against and the risks.
In such an environment, it's not surprising people take sides and dig in.
That is an interesting point, and I think there are at least two factors in this tribalism. Firstly, there is a faction of the population (or maybe most of us, at some time or other) who choose what they believe on the basis of whether it would lead to outcomes they would prefer, rather than on evidence for or against the proposition. Then there is another faction who assume that if you do not agree with them, then you must have bad motives. The sort of tribalism we are seeing here (and elsewhere) arises in the intersection of these tendencies, and people who take the first position over this matter are 'primed' to also take the second: they want the virus defeated, so if you are skeptical of this treatment, you must want the pandemic to continue, right? And people who realize that the evidence is not good may suspect those who insist that the treatment is effective of having ulterior motives.
As, well, "Hackers", we are probably used to being able to synthesize information we need ourselves. New API? Read the quickstart, patch together the documentation, you're good. A complex societal problem? I'll find the data on it, and form a better insight in 20 minutes than a journalist describing the story, who clearly doesn't understand fractions. New programming language? Give me a week, it's either like C, Haskell or Lisp.
Many of us also regularly read scientific papers, pick up new tools or frankly whole new academic fields, just as parts of our daily lives.
All of this, on the one hand, gives us expertise in coming up with our own, often better informed views about the world, on the other probably makes us overconfident about our information synthesis abilities in fields other than the wider CS.
Anything can be picked up and weaponised by the culture war process. At this point it's almost automatic. The clickbait machinery doesn't help either: the selling point of HCQ was its unapproved status, it was the "one weird trick doctors don't want you to know".
People took interest because the idea was seductive. COVID anxiety dominated the news cycle and made everyone feel hopeless. HCQ arrived on the scene as a purported miracle solution. Everyone wanted to believe it was the antidote to the COVID problems.
> For the HN audience it would be like people taking an almost tribal approach to go-lang vs rust, debating it on national television, without any of them knowing what a loop is.
In the business world, this happens far too often. Usually a non-technical manager reads hyperbolic internet chatter about how Rust is the only way to write secure code or that Node.js will boost productivity by allowing your front-end devs to write back-end code, then they assume their understanding is superior to that of the actual programmers.
Once the non-technical people start having strong opinions on technical decisions that disagree with the experts, it’s not a good sign for the company. Likewise, once the president started advocating for medications that weren’t supported by evidence, it was obvious that this administration had no idea what they were doing with their response.
Technically the Chinese Wuhan Institute was first to recommended hydroxychloroquine as a possible solution (among at least one other drug) months before this guy and the politicians ever published anything about it. There was also a small town US doctor who claimed anecdotal success among his hundreds of clients who was highly influential very early on. And tons of other speculative ‘experts’ talking about it on YouTube.
Then months later as COVID got really bad there was multiple bad science on both sides of the argument just muddied the water in an extreme event the entire population has a never experienced before in their lives. Causing mass desperation and flailing about.
I previously published a timeline on HN earlier that showed the UK also blocked exports of the drug at least a full month before the Trump brigades and bad papers came out. And other examples of authoritative institutions giving off signals and rumours which could easily be taken advantage of by people desperate to save family members lives. It was also listed as safe in small doses as by WHO so people were willing to take the risk before the full science was out.
I also remember the general consensus became that it was only useful as a prophylactic not a treatment after the fact when the infection was serious, so it was even harder to pinpoint good evidence when the doctors were giving it out to thousands and only a tiny amount got serious infections. Then the uselessness is even easier to hide with an easy exit argument.
It seems strange to me to target this one individual among a large group. Maybe he was the first to give it academic credibility with an actual paper?
I spoke to a senior academic in respiratory disease, and also a practicing doctor, from a top UK university. He was absolutely convinced that HCQ helps in moderate Covid cases, with near-immediately observable effects.
Thia still puzzles me, presumably he understands things like placebo effect and double-blind studies intuitively, and yet studies show no improvement.
On a similar note, the WHO recommendation against the use of Remdesivir is widely criticised by doctors in Poland, as based on a poorly-thought-through study. The claim is that Remdesivir helps patients only at certain stages of the disease, whereas the WHO study doesn't differentiate between such stages.
On the one hand, there's people who use the drug day-in-day-out, on the other a huge organisation which I'd think can do good-quality science. I remain confused.
I think the core issue is that the real answer science has had for months to most of these questions is "We don't know yet, we need some time to find out", and for many people living in a global pandemic that answer simply wasn't good enough.
There was a small suspicion and some previous studies that maybe (a big maybe) HCQ would help in some infections (parasitic and virotic - well, it does help with Malaria)
But that was that, a suspicion, not to take it as the holy grail of the disease
Of course but there are always people who will be desperate to get ahead of the curve before the science fully comes out (including nation states) and were willing to take risks.
It’s almost like everyone didn’t expect a basic human reality among a subset of the population to be a reality.
Fear has always been one of our strongest base motivations.
I’m generally cynical about all politicians and the lowest common denominator which is a hell of a lot of people. But I also don’t think the support for it during the early days was limited to just mom and pops boomers or whatever.
There’s plenty of blame to go around but I also think there was plenty of signals early on where the seriousness of the guilt is less than a lot of smug Twitter idealists are willing to admit.
My only question was why this one guy to target among a sea of other signals. But I also think from a purely skeptics (publication) perspective it’s fair they target the ones who aren’t ‘supposed’ to be among the stupid group and should know better (which would then exclude random family doctors, early recommendations for exploration, and the perpetually dumb politicians) and this guy was super influential as a microbiologist. So it might make more sense in that context.
> “It is hard to find an example of quackery that has spread so far, influencing the public health response to a deadly pandemic and creating widespread confusion across the entire globe.”
It isn't hard: the Lancet has published a completely made-up study written by an unknown team, before they retracted the paper. If I wanted to fuel conspiracy theories, I don't think I could come up with anything better.
To make sure HN'ers don't get things mixed up: Raoult has nothing to do with the Lancet's "study", and in an environment where such hogwash gets published, how is one clinician with the daily burden of the families of the many covid dead not going to try and do something?
> “It is hard to find an example of quackery that has spread so far, influencing the public health response to a deadly pandemic and creating widespread confusion across the entire globe.”
Or the WHO themselves claiming that masks do not work for months then suddenly reversing their position in the middle of the pandemic. But "Trust Science" they said.
They didn't lie. They always stop short of saying that masks don't work. They said that it is not a substitute for distancing (true), that health workers should be prioritized (true), that masks don't provide the expected level of protection when not properly fit (true), etc...
It is a bit misleading, sure, but no lies, they let secondary sources lie for them. So about misleading the public, I think we can say it is the case.
Now about "killing people". Did they kill or did they save people? Remember that people fought about toilet paper, even though there was no real shortage and it is just a comfort item (protip: you can wash your ass in the shower).
With masks, there was a real shortage, and it is an essential item for health care workers. We couldn't let nobodies stockpile hundreds of masks while people who are supposed to treat you get sick. That would really have killed people. And despite downplaying the importance of masks, is was still a mess.
I know a pharmacist who got tasked with supplying masks to health care workers who had masks "disappear" in transit, and health care didn't get their masks. Herself should have got N95 masks, but she didn't, instead only having surgical masks, and she had to keep them longer than recommended. She also had to deal with hysterical customers who "needed a mask" for no good reason. And it was as the importance of masks was downplayed. I don't want to imagine what would have happened if it wasn't.
Saying they didn't lie but that they misled the public is really nitpicky. They betrayed the trust that people had in their opinion. Maybe it was worth it to manipulate people "for their own good" but I doubt it.
"Or the WHO themselves claiming that masks do not work for months then suddenly reversing their position in the middle of the pandemic. But "Trust Science" they said"
Public Communications and Science are different things.
If masks are very scarce, and we need to ration, then we want to prioritize certain groups.
Once they are plentiful, the marginal benefit of masks becomes beneficial to the extent it doesn't interfere with front-line usage, in which case, we definitely want people o wear masks.
And so we use different words, mediums, forms of messaging to get people to change their behaviour, some of it more effective than others.
The medical community has to triage all the time, literally at your hospital right now, they are using their knowledge to ration the resources they have available at any given moment. If you complain of 'chest pain' then you go to the front of the line.
The Razor Award should be a thing now, because news about some kinds of science spreads quickly.
> If masks are very scarce, and we need to ration, then we want to prioritize certain groups.
Then why didn't they say so instead of lying to the public? "masks work, but we need to allocate them to health workers because we don't have enough of them". Anyone can understand that.
"Then why didn't they say so instead of lying to the public?"
? They quite clearly told us that they were prioritizing medical workers.
Read the WHO's guidelines yourself.
Here's the WHO guidance as of April [1] June [2], which is pretty early. You can see the guidance evolve during that time and it was still early.
Here is the CBC's public notice on March 25, a couple weeks before the epidemic hit hard in Canada [3]
"The advice on whether or not to wear masks to reduce the spread of COVID-19 has shifted since the start of the pandemic. Public health officials now say that wearing masks can prevent some potentially infectious respiratory droplets from spreading to others, but most still recommend that N95 masks, above, be reserved for health care settings."
Frankly, the only thing I remember about masks early on was 'get them to the front line workers' to the point where in my family we were going to donate our own N95s to the hospital, but they were already used.
Yeah don't remind me. People pulling numbers out of thin air to feed fuel to the fire (and apparently no reviewer with TL suspected that "AI driven data collection").
Since Trump publicised hydroxychloroquine the whole debate around it has become so poisoned by politics it's unable to find an unbiassed opinion. The Lancet study seemed to have rushed to publication purely to discredit Trump.
I don't want to advocate for Didier Raoult but calling such a renown professor all over the world a pseudo scientist is a bit harsh... What is the legitimacy of these judges? Only a few people have the knowledge to debate about this subject, it's all about politics right now, not science
Studies that use HCQ+ZINC+AZITROMYCIN EARLY (in the first 3-4 days after Covid symptoms appear) and in the proper dosage have consistently shown tremendous improvement in outcome.
But most studies apply those medicines AFTER HOSPITALIZATION (often 1-2 weeks after symptoms appear), which is far, far too late for them to be effective. Other studies gave massive overdoses of HCQ which can interfere with the heart rhythm. So the studies were "designed to fail" and did.
Raoult has nothing to apologize for; he was correct and has been vindicated by other properly-executed studies.
President Macron actually paid a visit to Raoult back in April. The visit probably inadvertently cast a gigantic spotlight on the shoddy (or at best preliminary) research. In my opinion it reflected quite poorly on the quality of Macron's scientific council.
More generally, I spent way too much time comparing the pandemic responses of various European countries. For France, one thing that stood out to me was an outsize focus by media and politicians on research by French scientists.
> President Macron actually paid a visit to Raoult back in April. The visit probably inadvertently cast a gigantic spotlight on the shoddy (or at best preliminary) research. In my opinion it reflected quite poorly on the quality of Macron's scientific council.
By the time Macron visited Raoult, the spotlight was already on and shining bright. He was more or less forced to visit him for domestic political reasons: Raoult tapped straight into the anti-establishment anti-elite yellow-vest zietgeist , if Macron hadn't at least shown some gesture towards him they would have seized the trope of the "intellectual snob who is too aloof to talk to the people and their hero". The populist politicians from the south of france were already riding the Raoult train by then: Estrosi, Melenchon etc
So he went, he talked, he got his photo taken, and he left. Raoult got the attention he craves, Macron took some bullets out of the guns of his enemies, and nothing much happened. I agree that a more principled stand would have been nice, but that's politics :/
It is a sad day for researchers worldwide when politics can shift your research efforts from "tried to do good research which could save the world" to "ermagehrd your science got used by orangeman bad let's name and shame you in public"
This award isn't about those other studies, it's about his choice to over-egg his research.
> Subsequent analysis of Raoult’s data found that his sample size was incredibly small, with only 6 patients given the hydroxychloroquine/azithromycin combination. The study was also found to be improperly controlled, and data was excluded for a number of patients whose condition worsened as they were either transferred to intensive care, or died. Subsequent studies have shown no clinical benefit for the use of hydroxychloroquine in patients with COVID-19.
> After Raoult’s study inspired a surge of interest in the use of hydroxychloroquine, [...]
His not very good research caused huge amounts of interest in hydroxychloroquine and distracted attention from other, far more beneficial, treatment.
If the small sample size and control method were include in the publication, which I believe they were, the blame lies with those who took the paper, claimed it was more than it was, and politicized the results.
Im not sure I want to live in a world where doctors and scientists cant publish their data.
> Science is the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence
Can we claim that we have some evidence based on a sample of 6 people?
I don't know if Chloroquine is effective on COVID 19, but I know that it's comically cheap and people took it for years against malaria without side effects.
So at worse it's a placebo.
On the other hand there's Remdesivir that's astronomically expensive, destroys kidneys and hasn't any effectiveness against COVID (even the OMS says so).
But it's still the recommended treatment in France since they forbid the chloroquine treatment.
Color me skeptical about their motivations but all the big proponents of Remdesivir have financial links with Gilead.
It can be worse than a placebo if it is not effective but physicians think it is: this would lead to patients not being given alternative (& effective) treatments - if any, or being less monitored since they are expected to get better with the drug.
The article incorrectly states the nominating committees intentions: Raoult was given the "Rusty Razor Award" so that he could buy a new electric shaver to replace his old (and indeed rusty) razor, which had long since lost it's edge and been abandoned by the good doctor.
France has for many years been chastised for its failure to properly fund scientific research and Raoult is yet another example of this sad neglect. Note also that "The Skeptic" is a British organization, Raoult is French, and that this is yet one more shot fired in two seemingly endless barrages across the Channel in both directions.
I guess other studies are perfect and survived this level of scrutiny.
Especially the "recovery" one, praised by everybody where the inclusion criteria was: "having flu like symptoms", without PCR. This is true science indeed.
> As of today, they updated the study with 3000+ patients.
Yes, this update was around July. They found an IFR of .7% with patient treated with HCQ. Lower than the 1.2% mortality rate in eastern France. But wait! In august, the IFR of eastern France was calculated again and was found to be around .7% (+-.3%) too?
SO since august, the narrative changed: HCQ soes not prevent people from dying at all, but prevent them to carry a viral load important enough to contaminate other people as much. With no real study, as doing so would be unethical. Convenient.
Honestly if you followed the story as much as i did (and i did buy HCQ early on, as my boss was a fan and sold me on Raoult with daily update), it became more and more ridiculous, with the organ point was the IFR recalculation in august, when i told myself i should be ashamed to have willingly believed something this early, coming from someone who, as Bergame started dying and Colmar was being infected, stated that the virus would not be coming to France, then, as my cousin bagged the 18th body in his hospital, posted a video called "Coronavirus: Game Over!", later edited and renamed.
For the HN audience it would be like people taking an almost tribal approach to go-lang vs rust, debating it on national television, without any of them knowing what a loop is.