Ebola kills on average 50%, so looks like Remdesivir was ineffective. There was no placebo control group due to ethical reasons.
This was likely a much younger population than with COVID patients and no doubt they had better kidney function than many elderly COVID patients, plus I expect the doses/duration was not the same, so I still think there may have been harm done with its use with COVID , but we just don't have any good data to show this, just many anecdotal reports
An argument can be made that none of the treatments were really effective, but that's confounded with all of the differences in variables. The progression of Ebola would suggest that unless a study captures treatment near the time of exposure then it's really a quick ride downhill from there.
I'm not arguing whether Remdesivir is safe or effective, but the fact that people have claimed that 50% of the people in the Remdesivir arm of the study died FROM Remdesivir is a flat out incorrect statement, and yet it's been reported many places. We don't need to rely on lies to argue that a lot of the treatment protocols for COVID were disastrous.
In the real world there is always a delay from exposure to seeking treatment, dx and then receiving treatment.
Thats why it would have been nice to have a control group since we really don't know the baseline mortality
rate
Were the other treatments more effective , or less harmful, or were the differences noise. Don’t know.
But you are right, this study should not be used as proof Remdesivir is deadly. First time I have read it although I must admit I didn't question that it was too dangerous for Ebola patients, although for reasons I mentioned we cant rule that out
Unfortunately people are less likely to question that which confirms their biases or beliefs, and there are those who seem to intentionally put out bad information to discredit those who question the narrative. Lots of mine fields out there and most of us don't have time to question everything
May 3, 2023·edited May 4, 2023Liked by Modern Discontent
This may really sound stupid...
...but I think most people would understand
You stop going out and initiate early prophylactic care IMMEDIATELY upon early symptoms; even mild congestion, sore throat, cough...
...many of these diseases spread significantly faster by symptomatic carriers
American Health Initiatives; exercise, diet, fresh air and sunshine, vitamins, minerals and naturopathic prophylaxis quercetin, nattokinase prior to the more “off labor”; nasal flushes, gargles, NSAIDS then Ivermection, Prednisone, with more easily prescribed Doxy, Zinthro, Keflex...
...maybe the days of worrying about superinfections from widespread basic antibiotic use is over
I just stocked up, including some Cipro for Anthrax and Potassium Iodide for biden’s*WWIII...
Or even doing things to strengthen your body and immune system prior to the exposure, including some of the outlines in the American Health Initiatives you mentioned.
It's not a stupid idea, and in reality having people not go out when sick would do a lot. If anything was to be learned about COVID it's that people who are sick should probably stay home. I've had coworkers who would take a day or two off only to come back wheezing in the lab- no one really needs that. At the same time, a life of sterility and lack of exposure is also detrimental as it would mean no robust immunity.
I generally take it that making the body antifragile is the best approach. Do what you can to strengthen the body, don't be too scared of getting sick if it means not living your life, but if you do fall ill you should be able to stay home and avoid others until better.
I easily read it while eating lunch (and didn't get lost in the biochem weeds as I often do) so I don't see this as a shorter post "failure". But YES, it is hard to see and/or confront your own biases! I think your readers truly appreciate this gift you have of stepping back from the data and viewing it without an agenda.
Thanks Clarisse! We really should be looking at all of this information from an unbiased perspective. All studies should be looked at critically to see where the faults lie.
Either that was a shorter post or I read it more quickly than usual. Very interesting. I've not heard anyone else speak out this way, although I have heard plenty of "run, death is near". Thank you.
And by the way, the same principle operates with software development (my thing), among many other disciplines. The earlier that a problem is detected and corrected, the lower the cost.
I measured my time based on Substack's little marker for the average reading time. I usually considered things below 10 min to be shorter but the past few have gone over so I was just arguing that I didn't stick to keeping things shorter.
I've commented a lot about the doomsday nihilism that seems to run abound now. It's like we've all become scared of even living and I find it all so strange.
I think this fact of early treatment works for everything a la the snowball effect. Easier to deal with things earlier rather than wait until things get worse and deal with far more issues. 🤷♂️
You seem to have lived a rather interesting life ClearMiddle! Although I also should remember that I likely lean much younger than the typical Substack writer/reader. At least within these parts of Substack.
Your doomsday nihilism observation seems somehow related to mine about the desire to point the finger at somebody, anybody else. When the focus is on the flaws of others, and bringing them to justice, and perhaps even getting rid of the worst of them, it isn't on ourselves and what _we_ do. Lacking that perspective, things can look hopeless. Trying to fix ourselves isn't quite the answer either. It takes letting go of nihilistic assumptions, and it takes something more even than that. We need help! Not with those other people. With ourselves.
This is what I write about, knowing that it means venturing into territory that many have determined not to venture into. My recent post "Ask..." goes a little deeper than usual. It is quite amazing what can come back in response to just asking. But then there is the matter of learning from that the lessons that we need to learn, and finding the pathway that leads somewhere. It is a path of service.
You may be younger than the typical Substack writer, but you seem to have caught on to a lot of things earlier in life than many. I was much, much slower, and I look back at those earlier years almost in disbelief. Interesting indeed. Not that the present is neat and tidy and clear, but I don't find it paradoxical. It actually makes sense. Lots of sense. It is designed to -- all this is part of a design. Check it out.
This is great, thank you! I totally agree with you - every study should be closely scrutinized whether we agree with it's conclusions are not. Thanks for scrutinizing this one.
Ebola, without supportive therapy had an incredible death rate. It has become obvious that supportive therapy and fluids made a large difference in survival.
I 'clicked off' the "deadly remdesivir" claim immediately, because was nonsensical to conflate 'death with remdesivir' with 'death from remdesivir', particularly with underlying Ebola. With respect to logical reasoning, that seems more of a bulldozer rather than nuance.
'Reasonable' hospital protocols excluded patients with liver failure and kidney injury from use of the remdesivir. The most sensible protocol would have been to choose another treatment altogether, since the main problem with remdesivir is that it was not shown to reduce mortality from COVID.
My objection to the use of remdesivir was always related to the high cost vs. general uselessness of the drug against COVID, and that it diverted attention and effort away from less INeffective treatments.
I was actually surprised at how many people I saw repeat that line. I saw a few YouTubers who mentioned it, and that's why I thought it was so strange that no one stopped to think that they are talking about a disease with a high case fatality rate. Surely that should tell us that not all 50% of those people just happened to die from Remdesivir alone. But again it's one of those things that people should probably know better than to repeat but apparently that isn't the case.
Interestingly, the FDA actually blamed nephrotoxicity on the carrier agent used in the IV administration of Remdesivir. They argued that the lyophilized form may be better, but the evidence is weak in that regard as well. So fingers are pointed to either the drug or the carrier agent and in both cases the evidence is rather weak. But again, I view Remdesivir from the lens of HCQ in that it probably shouldn't be used late in the disease when the risk of adverse reactions increases.
I may consider a write-up about Remdesivir's formulation. It sort of runs counter to all matters of pharmacokinetics to the point it was only available intravenously, and given that many places were closed it likely meant that it was only able to be administered within a hospital when someone is already seriously ill.
People often suspend common sense when they pick sides and join the war. I try not to do that, but it is a temptation among social animals.
The sulfobutylether-β-cyclodextrin can accumulate in people with reduced kidney function and become toxic. There was supposedly twice as much of it in the liquid formulation than in the lyophilized formulation. The active triphosphate metabolite of the pro-drug remdesivir, can also accumulate in kidney failure because it's renally excreted. So there were exclusion criteria for refusing to dispense it: renal, CrCl > 30 ml/min and hepatic function, ALT or AST >5 times the upper limit of normal.
Patients only got this drug in hospitals because of IV administration and further clinical need for admission. It was not to be given if the patient had exhibited symptoms of COVID 7 days or more previous to evaluation, because late treatment was considered futile due to the mechanism of action. It becomes an adenosine triphosphate analog and jams up viral replication by delaying RNA chain termination . Once the virus has really made people sick, the viral replication phase is over with, and their inflammatory reactions to the virus are what causes further troubles, (along with comorbidities and possible superinfections.)
HCQ was considered ineffective late in disease process, but ivermectin was considered to also have positive effects during the later, inflammatory phase of the disease.
I'm actually writing a post on Remdesivir given the renewed hysteria so I just noticed your comment (SubStack has been weird about comment updates...). I wrote a while back about the carrier agent. The FDA blames the carrier agent for the kidney dysfunction, the carrier agent doesn't seem to be it (maybe) so they're both pointing fingers at one another. I have heard about the liquid form and it makes sense. Part of my article will probably detail the issues in the design of Remdesivir and why that led to it being only provided via IV.
I wrote about HCQ a while back as well and so I'd have to look it up again. I believe it's ability to act as an ionophore was one of the issues related to the heart and increased QT interval, so it would make sense that later in the disease where patients may be compromised that the use of HCQ may run into problems.
Also some of the HCQ studies showing failure or toxicity used really high doses, that had already been known to be toxic. So many QT prolonging meds are used in hospitals, with some patients on multiples, I thought the big emphasis on that problem with HCQ was completely out of proportion, and likely a scare tactic.
Most patients coming in to the hospital with COVID had so many other issues that could cause kidney failure, that the remdesivir product is very unlikely to be the sole culprit. But it's generally inappropriate to add side effect risks to patients, using a drug with very low to no efficacy.
Ebola kills on average 50%, so looks like Remdesivir was ineffective. There was no placebo control group due to ethical reasons.
This was likely a much younger population than with COVID patients and no doubt they had better kidney function than many elderly COVID patients, plus I expect the doses/duration was not the same, so I still think there may have been harm done with its use with COVID , but we just don't have any good data to show this, just many anecdotal reports
An argument can be made that none of the treatments were really effective, but that's confounded with all of the differences in variables. The progression of Ebola would suggest that unless a study captures treatment near the time of exposure then it's really a quick ride downhill from there.
I'm not arguing whether Remdesivir is safe or effective, but the fact that people have claimed that 50% of the people in the Remdesivir arm of the study died FROM Remdesivir is a flat out incorrect statement, and yet it's been reported many places. We don't need to rely on lies to argue that a lot of the treatment protocols for COVID were disastrous.
In the real world there is always a delay from exposure to seeking treatment, dx and then receiving treatment.
Thats why it would have been nice to have a control group since we really don't know the baseline mortality
rate
Were the other treatments more effective , or less harmful, or were the differences noise. Don’t know.
But you are right, this study should not be used as proof Remdesivir is deadly. First time I have read it although I must admit I didn't question that it was too dangerous for Ebola patients, although for reasons I mentioned we cant rule that out
Unfortunately people are less likely to question that which confirms their biases or beliefs, and there are those who seem to intentionally put out bad information to discredit those who question the narrative. Lots of mine fields out there and most of us don't have time to question everything
This may really sound stupid...
...but I think most people would understand
You stop going out and initiate early prophylactic care IMMEDIATELY upon early symptoms; even mild congestion, sore throat, cough...
...many of these diseases spread significantly faster by symptomatic carriers
American Health Initiatives; exercise, diet, fresh air and sunshine, vitamins, minerals and naturopathic prophylaxis quercetin, nattokinase prior to the more “off labor”; nasal flushes, gargles, NSAIDS then Ivermection, Prednisone, with more easily prescribed Doxy, Zinthro, Keflex...
...maybe the days of worrying about superinfections from widespread basic antibiotic use is over
I just stocked up, including some Cipro for Anthrax and Potassium Iodide for biden’s*WWIII...
Or even doing things to strengthen your body and immune system prior to the exposure, including some of the outlines in the American Health Initiatives you mentioned.
It's not a stupid idea, and in reality having people not go out when sick would do a lot. If anything was to be learned about COVID it's that people who are sick should probably stay home. I've had coworkers who would take a day or two off only to come back wheezing in the lab- no one really needs that. At the same time, a life of sterility and lack of exposure is also detrimental as it would mean no robust immunity.
I generally take it that making the body antifragile is the best approach. Do what you can to strengthen the body, don't be too scared of getting sick if it means not living your life, but if you do fall ill you should be able to stay home and avoid others until better.
I easily read it while eating lunch (and didn't get lost in the biochem weeds as I often do) so I don't see this as a shorter post "failure". But YES, it is hard to see and/or confront your own biases! I think your readers truly appreciate this gift you have of stepping back from the data and viewing it without an agenda.
Thanks Clarisse! We really should be looking at all of this information from an unbiased perspective. All studies should be looked at critically to see where the faults lie.
Either that was a shorter post or I read it more quickly than usual. Very interesting. I've not heard anyone else speak out this way, although I have heard plenty of "run, death is near". Thank you.
And by the way, the same principle operates with software development (my thing), among many other disciplines. The earlier that a problem is detected and corrected, the lower the cost.
I measured my time based on Substack's little marker for the average reading time. I usually considered things below 10 min to be shorter but the past few have gone over so I was just arguing that I didn't stick to keeping things shorter.
I've commented a lot about the doomsday nihilism that seems to run abound now. It's like we've all become scared of even living and I find it all so strange.
I think this fact of early treatment works for everything a la the snowball effect. Easier to deal with things earlier rather than wait until things get worse and deal with far more issues. 🤷♂️
You seem to have lived a rather interesting life ClearMiddle! Although I also should remember that I likely lean much younger than the typical Substack writer/reader. At least within these parts of Substack.
Your doomsday nihilism observation seems somehow related to mine about the desire to point the finger at somebody, anybody else. When the focus is on the flaws of others, and bringing them to justice, and perhaps even getting rid of the worst of them, it isn't on ourselves and what _we_ do. Lacking that perspective, things can look hopeless. Trying to fix ourselves isn't quite the answer either. It takes letting go of nihilistic assumptions, and it takes something more even than that. We need help! Not with those other people. With ourselves.
This is what I write about, knowing that it means venturing into territory that many have determined not to venture into. My recent post "Ask..." goes a little deeper than usual. It is quite amazing what can come back in response to just asking. But then there is the matter of learning from that the lessons that we need to learn, and finding the pathway that leads somewhere. It is a path of service.
You may be younger than the typical Substack writer, but you seem to have caught on to a lot of things earlier in life than many. I was much, much slower, and I look back at those earlier years almost in disbelief. Interesting indeed. Not that the present is neat and tidy and clear, but I don't find it paradoxical. It actually makes sense. Lots of sense. It is designed to -- all this is part of a design. Check it out.
This is great, thank you! I totally agree with you - every study should be closely scrutinized whether we agree with it's conclusions are not. Thanks for scrutinizing this one.
Ebola, without supportive therapy had an incredible death rate. It has become obvious that supportive therapy and fluids made a large difference in survival.
I 'clicked off' the "deadly remdesivir" claim immediately, because was nonsensical to conflate 'death with remdesivir' with 'death from remdesivir', particularly with underlying Ebola. With respect to logical reasoning, that seems more of a bulldozer rather than nuance.
'Reasonable' hospital protocols excluded patients with liver failure and kidney injury from use of the remdesivir. The most sensible protocol would have been to choose another treatment altogether, since the main problem with remdesivir is that it was not shown to reduce mortality from COVID.
My objection to the use of remdesivir was always related to the high cost vs. general uselessness of the drug against COVID, and that it diverted attention and effort away from less INeffective treatments.
I was actually surprised at how many people I saw repeat that line. I saw a few YouTubers who mentioned it, and that's why I thought it was so strange that no one stopped to think that they are talking about a disease with a high case fatality rate. Surely that should tell us that not all 50% of those people just happened to die from Remdesivir alone. But again it's one of those things that people should probably know better than to repeat but apparently that isn't the case.
Interestingly, the FDA actually blamed nephrotoxicity on the carrier agent used in the IV administration of Remdesivir. They argued that the lyophilized form may be better, but the evidence is weak in that regard as well. So fingers are pointed to either the drug or the carrier agent and in both cases the evidence is rather weak. But again, I view Remdesivir from the lens of HCQ in that it probably shouldn't be used late in the disease when the risk of adverse reactions increases.
I may consider a write-up about Remdesivir's formulation. It sort of runs counter to all matters of pharmacokinetics to the point it was only available intravenously, and given that many places were closed it likely meant that it was only able to be administered within a hospital when someone is already seriously ill.
People often suspend common sense when they pick sides and join the war. I try not to do that, but it is a temptation among social animals.
The sulfobutylether-β-cyclodextrin can accumulate in people with reduced kidney function and become toxic. There was supposedly twice as much of it in the liquid formulation than in the lyophilized formulation. The active triphosphate metabolite of the pro-drug remdesivir, can also accumulate in kidney failure because it's renally excreted. So there were exclusion criteria for refusing to dispense it: renal, CrCl > 30 ml/min and hepatic function, ALT or AST >5 times the upper limit of normal.
Patients only got this drug in hospitals because of IV administration and further clinical need for admission. It was not to be given if the patient had exhibited symptoms of COVID 7 days or more previous to evaluation, because late treatment was considered futile due to the mechanism of action. It becomes an adenosine triphosphate analog and jams up viral replication by delaying RNA chain termination . Once the virus has really made people sick, the viral replication phase is over with, and their inflammatory reactions to the virus are what causes further troubles, (along with comorbidities and possible superinfections.)
HCQ was considered ineffective late in disease process, but ivermectin was considered to also have positive effects during the later, inflammatory phase of the disease.
I'm actually writing a post on Remdesivir given the renewed hysteria so I just noticed your comment (SubStack has been weird about comment updates...). I wrote a while back about the carrier agent. The FDA blames the carrier agent for the kidney dysfunction, the carrier agent doesn't seem to be it (maybe) so they're both pointing fingers at one another. I have heard about the liquid form and it makes sense. Part of my article will probably detail the issues in the design of Remdesivir and why that led to it being only provided via IV.
I wrote about HCQ a while back as well and so I'd have to look it up again. I believe it's ability to act as an ionophore was one of the issues related to the heart and increased QT interval, so it would make sense that later in the disease where patients may be compromised that the use of HCQ may run into problems.
Also some of the HCQ studies showing failure or toxicity used really high doses, that had already been known to be toxic. So many QT prolonging meds are used in hospitals, with some patients on multiples, I thought the big emphasis on that problem with HCQ was completely out of proportion, and likely a scare tactic.
Most patients coming in to the hospital with COVID had so many other issues that could cause kidney failure, that the remdesivir product is very unlikely to be the sole culprit. But it's generally inappropriate to add side effect risks to patients, using a drug with very low to no efficacy.
How many people in the United States were administered Remdesivir for COVID? What percentage of those patients died?