Pretty dense going for me. Maybe someone else can decipher.
https://threadreaderapp.com/thread/1259154540630364162.html
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At baseline the HCQ pts were sicker...the patients from HCQ group were mostly already in a mild to moderate Acute Respiratory Distress Syndrome (ARDS) while the patients from the other group were not, as the PaO2/FiO2 shows. The HCQ patient group had more hypertension, were older, and male. However, they used stat adjustments to try to make the populations similar. “Despite this extensive adjustment, it is still possible that some amount of unmeasured confounding remains.”
Further, the authors used a composite endpoint, intubation (going on a vent) OR death. Just looking at Death as a Primary Outcome
HCQ: 157 / 262 = 60%
No-HCQ: 75/ 84 = 89% !
COVID patients who developed a respiratory failure in the NY hospital turned out to be 4 times more likely to survive when treated with HCQ. So why not use the hard endpoint Death? Why confabulate a composite?
Here’s my guess: all patients are driven by institutional ‘protocol’ or practice to be an intubated COVID-19 patient ($39000) vs just a COVID-19 patient ($13000). Thus, by adding the ‘OR intubation’ part to the composite endpoint the positive effect on death alone becomes diluted out.
AND/OR they wanted to show no HCQ effect.
Good ole NEJM. Always political.
Here’s my guess: all patients are driven by institutional ‘protocol’ or practice to be an intubated COVID-19 patient ($39000) vs just a COVID-19 patient ($13000). Thus, by adding the ‘OR intubation’ part to the composite endpoint the positive effect on death alone becomes diluted out.
AND/OR they wanted to show no HCQ effect.
Good ole NEJM. Always political.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Thank you for the insight. The issues surrounding the use of HCQ are horrifying to me. The fact that the medical establishment and the media are willing to see people die to make us believe there is no treatment for this illness is a breach of trust that can never be clawed back. It will taint every interaction between doctors and patients for years. Those you trust the most.