Chloroquine, past and present • Hacker News Board

Re: Chloroquine, past and present

#251

Post by roenxi » Sat, Mar 21, 2020, 3:20 AM UTC

paulmd wrote: post #249

teddyvangogh wrote: post #224

Earlier quoted context omitted.

right. we need to wait for FDA approval. and since it's prescription only, you need to check with your doctor.

Doctors: "you need to wait for FDA approval!" also doctors: https://twitter.com/ml_barnett/status/1241172371404357633 https://twitter.com/JeffreyLowMD/status/1241172812762468353 https://twitter.com/amberwvzz/status/1241196003425992704

Society is about to ask the doctors to work in a crisis situation, for long hours, possibly under-equipped, surrounded by death and disease on a scale that we might not have seen for 100 years. We desperately need them to be in good health. We're asking them to be exposed to very high volumes of virus, potentially risking a bad infection. We're probably not going to pay them any more than usual either.

It isn't totally clear to me what you are implying, but there isn't anything wrong with them stocking up on hydroxychloroquine if it is likely to be effective against COVID-19. It would be a shame if they thought it worked but government regulation prevents them from prescribing it to ordinary patients.

Re: Chloroquine, past and present

#252

Post by roenxi » Sat, Mar 21, 2020, 3:25 AM UTC

jfkebwjsbx wrote: post #238

ggm wrote: post #203

Earlier quoted context omitted.

Scientists make mistakes. Scientists change their mind in the light of the evidence. Your distrust of this scientist is distrust of science. Please, don't do this.

What? There was more than enough evidence. They are the ones anti-science.

Not knowing the evidence doesn't make someone unscientific. Most scientists don't know most evidence.

If he had the evidence explained to him and then just assumed it would be different in France that would be unscientific, but we'd all need to read French to ague about that.

Re: Chloroquine, past and present

#253

Post by teddyvangogh » Sat, Mar 21, 2020, 3:36 AM UTC

paulmd wrote: post #249

teddyvangogh wrote: post #224

Earlier quoted context omitted.

right. we need to wait for FDA approval. and since it's prescription only, you need to check with your doctor.

Doctors: "you need to wait for FDA approval!" also doctors: https://twitter.com/ml_barnett/status/1241172371404357633 https://twitter.com/JeffreyLowMD/status/1241172812762468353 https://twitter.com/amberwvzz/status/1241196003425992704

Faulty generalization = the fallacy of examining just one or very few examples or studying a single case, and generalizing that to be representative of the whole class of objects or phenomena.

Re: Chloroquine, past and present

#254

Post by paulmd » Sat, Mar 21, 2020, 3:37 AM UTC

roenxi wrote: post #251

paulmd wrote: post #249

Earlier quoted context omitted.

Doctors: "you need to wait for FDA approval!" also doctors: https://twitter.com/ml_barnett/status/1241172371404357633 https://twitter.com/JeffreyLowMD/status/1241172812762468353 https://twitter.com/amberwvzz/status/1241196003425992704

Society is about to ask the doctors to work in a crisis situation, for long hours, possibly under-equipped, surrounded by death and disease on a scale that we might not have seen for 100 years. We desperately need them to be in good health. We're asking them to be exposed to very high volumes of virus, potentially risking a bad infection. We're probably not going to pay them any more than usual either. It isn't total…

> It would be a shame if they thought it worked but government regulation prevents them from prescribing it to ordinary patients.

It doesn't. It's FDA-approved, it's just off-label for this use.

> It isn't totally clear to me what you are implying, but there isn't anything wrong with them stocking up on hydroxychloroquine if it is likely to be effective against COVID-19

lmao are you implying that doctors are self-prescribing or using straw man prescriptions because they just love their jobs that much?

bud, if that's a good policy we can get the chain of command at the hospital to do it, not Dr Nick writing a fake prescription for his dog and taking it on the sly.

Oh yeah but that's not an FDA approved use and there's "no clinical evidence that it works".

What I'm saying is there's a huge disconnect between what doctors are saying, and what they're doing. There is pretty strong evidence it works. There is a half century of evidence it's safe. That's why they're willing to give it to their family members.

Doctors just don't want to cause a rush on the supply. But they themselves want to hoard it for their family.

BTW the whole reason Trump mentioned this is because he's on it. Someone told him these pills would help keep him from getting infected, and he blurted it out because he has no filter and just says whatever crosses his mind.

Re: Chloroquine, past and present

#255

Post by SketchySeaBeast » Sat, Mar 21, 2020, 4:08 AM UTC

m0zg wrote: post #248

SketchySeaBeast wrote: post #168

Earlier quoted context omitted.

And if that wants to get organized I can see how that would work. "Get sick to beat the rush", however, is not that - it's an action where the only good outcome would be if only you do it, which I think is a definition of selfishness.

Thats fine, but as things are right now, we're short on beds in a few places, and are wasting beds everywhere else. Seems like a waste of the precious resources to me.

You do realize that any decision made today will reap benefits in more than a week, right? Those beds may no longer be wasted by the time you're ready to take advantage of them.

Re: Chloroquine, past and present

#256

Post by jac241 » Sat, Mar 21, 2020, 4:08 AM UTC

paulmd wrote: post #228

pkaye wrote: post #223

Earlier quoted context omitted.

Do doctors "get a cut" when their patients buy from a neighborhood pharmacy?

They get a couple hundred bucks for a 5 minute office visit to write the prescription, yeah. I'm fine if there's a serious reason for a physical examination, but a lot of stuff the doctor is effectively filling the role of a pharmacist: telling you side effects and if you have this set of serious side effects then to stop it and/or go to a hospital, here's your script, pay at the front desk. A lot of stuff is unneces…

They don't make a couple hundred bucks. A 99213 established outpatient visit is worth 0.96 work RVUs * $36.0391 Medicare conversion factor = $34.59 for a standard outpatient visit. Even if you add the facility RVU = 0.48 + malpractice RVU 0.08 that is $54.78 for an outpatient visit. To make a couple hundred bucks, you need to do something like placing a stent for someone who is having a heart attack: CPT code 92941 - 12.31 work RVUs = $443.64.

All this information is available online. You can look up the physician fee schedule straight from the CMS. https://www.cms.gov/apps/physician-fee-schedule/search/searc... . Here are the cardiology codes - https://myheart.net/cardiology-coding-center/coronary-interv...

To add an additional data point, doing a heart transplant is 89.50 wRVU * 36.0391 = $3225. I don't think doctors are living as well as you think. CPT code 33945.

Re: Chloroquine, past and present

#257

Post by anonuser123456 » Sat, Mar 21, 2020, 4:09 AM UTC

gumby wrote: post #91

cameldrv wrote: post #62

We definitely want more studies, but IMO we're reaching a tipping point. We have anecdotal evidence from China and South Korea, and this quite flawed, but at least data-containing study from France. Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. COVID isn't quite as bad as c…

> Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. The FDA's Office of new drugs is split into divisions (dermatology, oncology etc) and the different divisions have different approval criteria as you mention. From my Onco friends' PoV, cancer patients are pretty much assumed…

COVID-19 is also hepatotoxic?

Re: Chloroquine, past and present

#258

Post by jussij » Sat, Mar 21, 2020, 4:18 AM UTC

takinola wrote: post #166

cameldrv wrote: post #62

We definitely want more studies, but IMO we're reaching a tipping point. We have anecdotal evidence from China and South Korea, and this quite flawed, but at least data-containing study from France. Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. COVID isn't quite as bad as c…

I don't know about the efficacy of Chloroquine in treating COVID-19 but I would imagine that we already know a lot about the safety of dosing people with the drug. Any one growing up in the tropics during the 70s or 80s took regular doses for malaria treatment. The main adverse reaction that often happened was a crazy amount of itching (it would last for 3 days and would not let up even when you were trying to fall a…

I remember taking malaria tables in preparation for a holiday trip to the tropics.

I would have been 12 or 13 years of age and this would have been in mid 70s.

As part of that same preparation I also had 2 jabs (I think for Yellow Fever and Cholera) and if I remember correctly I had to take one malaria tablet a day, for a period of two weeks prior to the start of the trip.

I honestly don't remember any side effects from taking those malaria tablets, but I do remember the 2 days of numbing pain in my arm, which I assumed was caused by the two jabs.

Re: Chloroquine, past and present

#259

Post by zamalek » Sat, Mar 21, 2020, 4:19 AM UTC

aaavl2821 wrote: post #232

jennyyang wrote: post #197

Earlier quoted context omitted.

One of the comments in the article: I prescribe Plaquenil extensively in patients with autoimmune conditions.The safety profile of this drug is excellent. It is also still used for malaria prophylaxis in healthy individuals .it is not a new drug. I don’t see the reason of labeling it as dangerous. The question is : does it work for Covid19 prevention and treatment? The answer is “the current limited evidence suggests…

Fwiw, Plaquenil is hydroxychloroquine, a less toxic derivative of chloroquine. It has a different safety profile than chloroquine The French study of HCQ had several limitations. Including that it was very small and some patients who got HCQ and progressed to go to the ICU were excluded from the study. Thus making the drug look better than it is HCQ is not likely to be a miracle cure. It may be useful in combo with o…

> It may be useful in combo with other drugs

Weren't the first studies done in combination with azithromycin (which is bizzare, as that's an antibiotic)?

Re: Chloroquine, past and present

#260

Post by jac241 » Sat, Mar 21, 2020, 4:25 AM UTC

pkaye wrote: post #223

paulmd wrote: post #214

Earlier quoted context omitted.

This whole incident hasn't done much to shake my impression that US doctors are interested first and foremost in making sure they get their "cut" on every prescription, even when the drug is relatively innocuous. Like fine, we can have this discussion about chloroquine. It's behind-the-counter in the UK, so on par with sudafed in terms of access control, and OTC in a lot of countries that actually have to deal with m…

Do doctors "get a cut" when their patients buy from a neighborhood pharmacy?

No, the Stark Law prevents that (self referral, referring to another business the physician has a stake in) https://en.wikipedia.org/wiki/Stark_Law . Physicians are paid according to a fee schedule that decides how much each thing they do is worth. Each procedure or office visit is assigned a work Relative Value Unit, which is multiplied by a conversion factor ($36.0391 for Medicare) to determine how much a physician gets paid. Private insurance generally follows the Medicare RVU scale, and has an adjustment ~120-150% for the conversion factor (just a guess, only a student). This conversion factor was $36.6873 in 1998, so, adjusting for inflation, Medicare values each thing a physician does at 62% of what it did in 1998. I hate that most of my posts on this site are about this topic, but so many people on this site get it so wrong when it comes to how physicians are paid.