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Showing content with the highest reputation on 06/04/2020 in all areas

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    Just listened to most of the latest update from the EM Rap group. Most telling is how little new there is. Cases seem to be moving to South America globally. But most of the rest of it is fine tuning things we were at least previously onto. How to treat ICU patients, etc. Unfortunately the news on the treatment front is not as great as it seemed earlier. First, yet another negative hydroxychloroquine study. Not an RCT, so the final nail is not been hammered yet, but the trends are not positive. Since that drug had already been trending pretty poorly, I'd say that for me the most disappointing news was actually a deep analysis of the remdesivir study. This is a pretty good example of part of what I've been on about. The establishment has jumped on board with the recently touted positive study on this drug. If you listen to some experts and most of the media, this is the first "proven" treatment. In fact, it says that very thing in an article right now on Yahoo life. So there it is right? Maybe, maybe not so fast. I mentioned a while ago that over my career I've found several scientific experts with a brilliant ability to break down the quality of studies. Maybe none has been as universally impressive as a guy named Jerome Hoffman in California. He is an academic ED doc with statistics background who has been breaking down 30 scientific articles/month for 30 years. He's retired now, but EM Rap brought him out of retirement to have a look at the latest remdesivir study. His opening line was, "It's even worse than I thought". Below is the entire hour and a half update, can't say it's worth watching the whole thing, but I include it here for the part that introduces Jerry Hoffman and his critique of the study, its worth a look, at around 27:00 to about 35:00. 7 minutes. It shows just some of the difficulties in "proving" something scientifically. Bottom line, this latest remdesivir study is far from the proof it touts. About the only thing one can say with a study that is poorly done as this, is that the effect can't be monumental, because that would have shown up far far bigger. If this drug works, it will be a small effect, and there is still a strong chance this will end up being ineffective. But watch the experts, even the government ones, who will all have to respond to this seemingly positive study with a massive expansion of the use of this drug. Once that becomes standard care, it will be very very hard to stop it, even if it is increasingly proven ineffective, both because of how huge this whole Covid thing is, and the lack of alternative treatments. The only thing that would stop it, is a huge RCT proving no benefit or harm, or a clearly superior alternative. I still hope for it to work, but it is far from proven. Really, listen to Jerry Hoffman's explanation if this issue interests you. It's 7 minutes of insight into how real scientists practice peer review, and why that is such a critical step in the scientific proof process.
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