Maybe it’s best to start by understanding the meaning of the word “significant.” Like many words, it has several possible meanings, not all of which are clearly related. The first definition, according to Merriam Webster, is “having meaning; especially: full of import.”
You have to move down along the list of definitions until you get to 3.c “probably caused by something other than mere chance.” This is the meaning that is better expressed by the term “statistically significant” and has a special meaning in science and medicine.
To say that a result is statistically significant means that there’s limited likelihood that the observed result happened by chance. Usually the measure of statistical significance is set at 5% – that there’s only one chance in 20 that something influenced the result so that if a patient got better it was because of the drug, and not because they would have recovered without treatment. This is particularly important when evaluating one of President Trump’s tweets, and a statement made at a press conference on March 21,
“HYDROXYCHLOROQUINE AND AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains – Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents ) … be put to good use IMMEDIATELY. PEOPLE ARE DYING. MOVE FAST, and GOD BLESS EVERYONE!”
The president was referring to a study titled “Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial,” which was published in the International Journal of Antimicrobial Agents, written by a team of researchers from Marseilles University.
The good news is that patients who were treated with the drug combination showed some level of improvement. The bad news in that it was a small study, open label, non-randomized. The best studies have a large number of subjects, and are double blinded, so that neither the patients nor the clinicians know whether the test subject is being treated with active drug or placebo. Researchers have a strong impetus for getting favorable results, whether it’s to increase their chances of getting more research grants or just for the satisfaction of making the world a better place.
There seems to be no question but that President Trump wants to be appreciated. He also wants to be re-elected, perhaps from fear that if he stops being president somebody will get a look at his tax returns. So far the research into the use of chloroquine and hydroxychloroquine have come from China and the combination with azithromycin came from France, but there’s still some satisfaction to being the first with the good news. Unfortunately for the president, a recent poll from Business Insider found that “Americans trust Dr. Anthony Fauci, the nation’s top infectious-disease expert, and New York Gov. Andrew Cuomo the most when it comes to official guidance on the COVID-19 outbreak … Fauci and Cuomo received the highest marks, and President Donald Trump and Treasury Secretary Steve Mnuchin got the lowest average scores.“
The promise of the hydroxychloroquine and azithromycin combination certainly looks good. Here are two well-established drugs that seem to work, even if only in a very limited study. There have been several preliminary studies going back over a decade to show that chloroquine has some degree of efficacy against coronaviruses, but what seems more intimidating is the number of cures that are coming out of the woodwork.
Unfortunately, a review article “Of chloroquine and COVID-19,” published in Antiviral Research (5/20), after a detailed discussion of studies of chloroquine and hydroxychloroquine, states, “Altogether, the assessment of previous trials indicates that, to date, no acute virus infection has been successfully treated by chloroquine in humans.” A review article in the Indian Journal of Pediatrics summarizes the state of the art: “Treatment is essentially supportive; role of antiviral agents is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions.” There is reason for hope, but no cure -– not yet.
On the other hand, perhaps to support President Trump’s optimism, there is a report on LibertyNewsNetwork.com. For those unfamiliar with this outlet, LNN warns, “The Liberal Elites have corrupted all mainstream media and are going ALL-OUT to ensure President Trump doesn’t get re-elected in 2020. They’re regulating the news, lying to our faces, and misleading every-day Americans with falsified news. Liberty News Network is devoted to delivering you the stories that matter most, and BRINGING LIGHT to left’s outright neglect for the truth!” To this end, LNN reported “Dr. Vladimir Zelenko has now treated 699 coronavirus patients with 100% success using Hydroxychloroquine Sulfate, Zinc and Z-Pak “ Z-Pak is a proprietary packaging of azithromycin, brand name Zithromax. Dr. Zelenko may not have his results published in the New England Journal of Medicine, but he has been interviewed by former New York Mayor, Rudy Giuliani and by Sean Hannity. As for publications, Dr. Zelenko apparently prefers Facebook. In other words, wash your hands and keep your distance – it’s the best advice you’ll get for a while.
Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.
From The Progressive Populist, May 1, 2020
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