Low dose of hydroxychloroquine – but lots of questions

Last week, a new retrospective study from Tongji Hospital in Wuhan was published in Science China Life Sciences (a Springer Link journal). The study found 47% fatalities in critically ill #COVID19 patients that were given regular treatment, and only 19% fatalities in patients treated with low doses of hydroxychloroquine (HCQ).

These results sound amazing.

But I took a closer look. And I have lots of questions.

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Animal ethics misconduct: mice with very large tumors

In the past few years I have found some examples of papers showing photos of mice or rats with very large tumors. Some of these tumors appear to go far beyond what animal ethics guidelines consider to be acceptable.

This post contains images that might be disturbing to some viewers. So, please proceed with caution.

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COVID-19, small RNAs, and conflicts of interest

Recently a paper published in Nucleic Acid Therapeutics, a Mary Liebert publication not to be confused with the more glamorous Nucleic Acid Research journal, was brought to my attention. It described the potential use of small RNAs as a therapeutic against SARS-CoV-2.

Alas, it is most memorable because of the alarmingly short time-to-acceptance, lack of references, and the omission of several conflicts of interest.

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Thoughts on the Prevent Senior study

A new study from Brazil is reporting significant positive effects of hydroxychloroquine (HCQ) + azithromycin (AZM) on early-stage suspected COVID19 cases. The study was posted as a preliminary manuscript draft on Dropbox a couple of days ago. I just tweeted my thoughts in a long thread, but here is a bit more polished version.

Update 20 April: It was announced today that the study described below has been suspended because of ethical violations. As pointed out by Natalia Pasternak and Carlos Orsi and Ricardo Parolin Schnekenberg (see Additional Reading links below), the study had already started before the ethical approval had been obtained. This could be figured out by looking at the disclosed study days in the preprint and the trial registration at the Clinical Trials website.

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Amazing rates

The IHU Mediterranee Infection, the Marseille hospital that claims that hydroxychloroquine + azithromycin treatment will cure almost everyone infected with COVID-19 has been reporting very low death rates for COVID-19 patients. As of today, their website reports that the IHU has a much lower death – 1.7% – than the worldwide COVID-19 mortality rate of 6.2%.

While that might look amazing at first glance, these numbers are not surprising, given the high numbers of virus tests that the institute has been performing. Let’s take a closer look at their testing to better understand how the Marseille hospital can get such low mortality rate numbers.

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JACC wins the first “This Image Is Fine” Award

In a new segment on this site, I will start handing out “This Image Is Fine” awards for papers containing images of concern, but where the Editors do not think there is a problem. This first installment of the “This Image Is Fine” award will go to the Journal of the American College of Cardiology (JACC) for deciding that images containing large amounts of duplicated elements are not worth investigating.

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ISAC shares concerns about the Hydroxychloroquine and Azithromycin paper

The International Society of Antimicrobial Chemotherapy (ISAC) has shared concerns about the Gautret et al. paper published in its own journal. This paper, published under senior authorship of Didier Raoult from the IHU-Méditerranée Infection in Marseille, describes a small study that showed remarkable effects of Hydroxychloroquine and Azithromycin treatment in COVID-19 patients.

After world leaders and politicians started to tweet and endorse this study, many people pressured health officials to start treating COVID-19 patients with this regime, although the study was small and not yet confirmed by independent, larger, and better randomized other studies.

Several scientists and medical professionals, including myself, had concerns about how patients were assigned to each treatment group, how PCR results were reported, why patients with a poor outcome had been left out of the final results, and how this treatment could potentially result in serious side effects. I wrote about my concerns in this blogpost and on PubPeer.

Now, ISAC, who is overseeing the International Journal of Antimicrobial Agents, the journal that published this study, has joined in those concerns.

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