The official "let's impeach Trump" thread
- Thread starter colton
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D
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If he weren’t president he’d be sued for defamation. I’m totally convinced that we need to rid ourselves of the DOJ policy of shielding presidents from criminal prosecution. Trump has proven ad nauseam the fallacy of that policy. If he were actually competent, imagine the damage he could do?
Nothing burgers
One thing I hadn’t clarified in the other thread (and perhaps I should post this there) was regarding the issue of side effects (i.e. risk for arrhythmia), as this has been the biggest thing that (in my personal opinion) has been blown out of proportion. The outcome measure regarding de-novo arrhythmias is the largest outcome variable that I feel is significantly skewed by selection bias and may lead to a distorted picture of what’s happening.
While I’m not a cardiologist, the largest thing I do on a regular basis that interacts with cardiology is the issue of QT prolongation, which is the major concern that’s been highlighted with hydroxychloroquine (and it’s combination with azithromycin). In short, what this means is that each time the heart beats, it’s precipitated by an electrochemical pulse that contracts the heart muscle. After each beat, the heart has to “recharge” (repolarize) and as the time increases for repolarization (as can be influenced by a number of drugs), it increases the risk of developing a specific arrhythmia (torsades de pointes) that can be fatal. The absolute risk of this is hard to quantify. If the QT interval gets beyond a certain threshold, it starts drastically increasing (as a multiplier, but not exponentially) that risk. A lot of this can be quite theoretical, and a measurement of QT interval isn’t static, so you’re really kind of looking at ballpark ranges when you evaluate this.
Okay, so back to the study. Both hydroxychloroquine (or chloroquine) and macrolide antibiotics are associated QT prolongation. This has been the big scare regarding this (both in the medical community, but even much more so in media). The study associates the treatment groups with much higher rates of de-novo ventricular arrhythmias. For this definition, they’re broadly using ventricular arrhythmias (including premature ventricular contractions) but not capturing torsades de pointes (the most relevant and correlated one). These range in severity. PVCs (premature ventricular contractions) are benign. They’re also common. They’re also going to be found in people without symptoms. But in any case, I’m a bit unclear on how some of this data is mined, because PVCs, present or not, is an unusual thing to end up getting tagged in a chart (but they don’t give a breakdown, so this very well could be inconsequential). But they even define the non-sustained ventricular tachycardia as being as short as 6 seconds.
If we’re talking about the differences in mortality, then this is a fair assessment (though there are a couple other things I can comment on in further detail, if desired), but if we’re talking about de-novo arrhythmias, then this would probably be the most limited part of the study from what I could observe. This would be the most obvious way in which the naturalistic and observational confounders come into play. Those who are being given any of the studied treatments, especially in light of public discussion regarding this in headlines, are going to be significantly more likely to be on telemetry (continuous heart-rhythm monitoring). I’d don’t have an exact figure on this, but I’d imagine that most (80-85%, conservatively, if not higher) are going to be on telemetry. Anyone not receiving any of the treatments would be fairly unlikely to be on telemetry (I’d honestly guess less than 10%, but this could be off if some places are being cautious and putting people on it as a protocol), unless there’s some other reason independent of COVID that would guide that decision.
If there’s a true mortality difference between groups, I’d be fairly skeptical of it being due QT prolongation (something that wasn’t a measure here, they just went to the next domino). If this were following a standardized protocol, I think you’d see a decent sized approximation in that particular outcome. Why this is important: hydroxychloroquine is a drug that’s still used for other purposes, and has been used for quite some time, and the highlighting of its cardiac effects has only come about as political collateral, which embeds deeply within society’s understanding of science and medicine, and will start weighing in to treatment decisions years from now, not because of any relevance to the issue being treated at hand or its risks and benefits, but because of emotional association. But that won’t be unique. Much of what transpires within medicine is embedded in cultural phenomena that what we think is or isn’t happening is actually far separated from reality, and has far more to do with our beliefs (as patients) and the larger context in trying to find meaning in suffering.
D
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What would we be saying if another leader of a foreign country was threatening private companies like this? What would we be saying about a leader who is threatening to Regulate or shut down the Internet?
Has any republican spoken out about this? Is Mike Lee down with this? Chris Stewart? Are fellow Utahns down with this?