Guest essay by Eric Worrall
The FDA has just revoked emergency approval of HCQ for Covid-19 patients, a decision criticised by President Trump. IMPORTANT – a tweet provided by MP puts a different spin on today’s events.
Hydroxychloroquine: US revokes emergency approval of malaria drug for Covid-19
Food and Drug Administration says drug is unlikely to work against coronavirus and notes heart risks.
Guardian staff and agencies
Tue 16 Jun 2020 10.19 AESTUS regulators revoked the emergency authorization for malaria drugs championed by Donald Trump for treating Covid-19, amid growing evidence they don’t work and could cause serious side effects.
The Food and Drug Administration (FDA) said on Monday the drugs hydroxychloroquine and chloroquine were unlikely to be effective in treating the coronavirus. Citing reports of heart complications, the agency said the drugs’ unproven benefits “do not outweigh the known and potential risks”.
Trump criticized the FDA decision. “I took it and I felt good about taking it. I don’t know if it had an impact, but it certainly didn’t hurt me,” Trump said on Monday.
Trump said there had been “great reports” out of France, Spain and other places, without offering any evidence or further explanation. France is one of the countries that has already stopped using the drug for Covid-19 patients.
In a separate announcement, the FDA also warned doctors against prescribing the drugs in combination with remdesivir, the lone drug currently shown to help patients with Covid-19. The agency said the anti-malaria drugs could reduce the effectiveness of remdesivir, which the FDA cleared for emergency use in May.
…
The drugs can cause heart rhythm problems, severely low blood pressure and muscle or nerve damage. The FDA reported on Monday that it had received nearly 390 reports of complications with the drugs, including more than 100 involving serious heart problems. Such reports represent an incomplete snapshot of complications with the drugs because many side effects go unreported.
…
Read more: https://www.theguardian.com/world/2020/jun/15/hydroxychloroquine-coronavirus-fda-emergency-authorization
The FDA are correct that there is no definitive proof Hydroxychloroquine works, but many doctors who have tried it have been impressed.
There has been an unseemly scramble to try to claim Hydroxychloroquine does not work, including a now retracted study based on questionable data.
The apparent irregularities surrounding oversight of Hydroxychloroquine, a drug which was widely used for decades in Malaria prone regions, in my opinion undermine the credibility of the entire medical oversight establishment.
h/t Gary Ashe – The Association of American Physicians and Surgeons filed a lawsuit 2 weeks ago to overturn the FDA restrictions on hydroxychloroquine.
h/t MP – IMPORTANT It appears the Guardian may have misinterpreted the actions of the FDA, or perhaps I misinterpreted what the Guardian was trying to say. It appears that doctors are now free to provide Hydroxychloroquine however they see fit.
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Another Highly-Touted Hydroxychloroquine Study Turns out to Be a Joke
https://www.redstate.com/bonchie/2020/06/15/another-highly-touted-hydroxychloroquine-study-turns-out-to-be-a-joke/
Chloroquine and hydroxychloroquine bind to melanin in the retinal pigment epithelium (RPE) and cause damage to the macular cones outside of the fovea. The drugs inhibit RPE lysosome activity, reduce phagocytosis of shed photoreceptor outer segments causing an accumulation of outer receptor segments. In response, pigment-containing RPE cells migrate into the outer nuclear and outer plexiform layers of the retina resulting in irreversible photoreceptor loss and RPE atrophy.[3] HCQ has a long half-life (about one month) and takes about half a year to achieve full elimination from the body; this is significant when managing minor side effects such as itching and corneal deposits and major ones such as retinal toxicity and explains continued maculopathy even after discontinuation of the medication. Corneal deposits (called vortex keratopathy or corneal verticillata) result from binding to cellular lipids and deposition of the drug in the basal epithelial layer of the cornea. Discontinuation of the drug usually causes the deposits to disappear over time.
https://www.ncbi.nlm.nih.gov/books/NBK537086/
It’s also not the only ionophore choice to use with Zn to block viruses.
I first read about the HQC +zinc in an article by Bill Sarde back in late Jan,/early Feb> He mentioned that quercetin was also an ionophor for zinc, and that it is found in several foods including red apples. Since an apple has been part of my daily breakfast for years, I added a zinc supplement, upped my daily vit D and C a little, and went on with life as usual.
The VA (my primary care) study I looked into used people already in critical care on ventilators, and gave them 4x the normal dosage. Not a relevant study at all. Also turns out that the rush to ventilators did more damage than helped. I my opinion, money is the issue–big pharma can’t control the price on a 70 year old generic.
It is in fact quite safe for the majority of people; it has been in wide use for decades.
However it is Orange Man’s drug therefore also bad and, further, inexpensive and readily available so drug companies too will not like it.
Robert,
Let’s say, for the sake of argument that “It is in fact quite safe for the majority of people; …” What if it were to become the drug of first choice for everyone who shows symptoms, and you were one of the ‘minority’ of people unfortunate enough that your statement doesn’t apply? Physicians are bound by an oath to “First, do no harm.”
Profile and monitor. The risk factors are known, including a separation of cause and effect attributable to the disease. HCQ+Zn+AZ is part of a Planned Pathogen (PP) protocol. Either way, it’s a choice (not Choice, which, contrary to the oath, has widespread physician backing, with nearly 100% excess mortality, and sometimes greater) in risk mitigation.
Read this
Clyde Spencer: Your logic then must proceed as follows. “No one should treat anyone with any kind of treatment that is not 100% without side-effects. No surgery, nothing with any risk, no matter how low. Take the aspirin and Tylenol off the shelf too, people die every year from these two widely beneficial drugs.
Advice, to reduce the dilution of excellent posts here, think before you write such nonsense. When you know you don’t know what you’re talking about, pause and think, what harm can my baseless assertions do to the conversation.
That said, there have been cogent statements against the use of HCQ and Zn, but your statements are not among them.
Dihydrogen monoxide is also a deadly poison.
They haven’t banned Dihydrogen monoxide yet, despite all the signatures on all the petitions! It’s an outrage!!!! 😀
LOL: I worked developing low cost Cloud SCADA for the water industry, and they have banned the extraction of water in some wells, for overuse and for other reasons. OK… but the FDA has not banned it 🙂
Strange, another claim that CQ is used for amebiasis.
https://www.health.harvard.edu/a_to_z/gastrointestinal-amebiasis-a-to-z#:~:text=Gastrointestinal%20amebiasis%20is%20treated%20with,tinidazole%20(Tindamax%2C%20Fasigyn).
https://www.thegatewaypundit.com/2020/05/president-el-salvador-announces-taking-hydroxychloroquine-says-world-leaders/
President of El Salvador Nayib Bukele has announced that he is taking hydroxychloroquine as a preventative measure against the coronavirus.
Bukele told reporters on Tuesday that “most world leaders” are doing the same and has questioned why world leaders are being advised to use it while the public is not.
I fear we have descended into health policy bedlam. HCQ is an ionophore that works in combination with Zn to inhibit virus replication. So here are two basic questions: 1) Where is Zn mentioned in combination with HCQ in any of this policy ping pong? and 2) How are clinical results being impacted by use of HCQ with Zn in late stage critical care vs. earlier monitoring stages of infection? Early and mid stage treatment could save a lot of lives if the studies were rationally conducted and reported.
Followup question: Is there a study or health guideline that says Zn with ionophores are ineffective at any stage of COVID-19 infection? I thought not.
14 case studies show good results in HCQ Prophylactic and Early Treatment for COVID-19
https://docs.google.com/document/d/1vDD8JkHe62hmpkalx1tejkd_zDnVwJ9XXRjgXAc1qUc/edit
As in the case of AIDS, I guess we will not see consideration of drug combinations until well after the pandemic is in later stages of harm.
Is it really that hard to study and report on HCQ with Zn and at what stage for best results? Does stress cause a human (health policy) mental tick to arise that can only focus on one thing at a time?
“As in the case of AIDS, I guess we will not see consideration of drug combinations until well after the pandemic is in later stages of harm.”
That’s when they move to less toxic drugs that don’t ki!ll patients like the toxic drugs they initially give them do. Then when deaths drop they claim the less toxic drugs helped them. That’s what they did with AZT during AIDS. AZT would ki!ll any healthy person. Also they did it during SARS with ribavirin, another DNA chain terminator (aptly named “nukes”) like AZT.
Everyone touts Germany as the shining light over their coronavirus response. As of yesterday (15th June) they had reported “only” 8,887 covid-19 deaths from a population of 83 million, which is significantly better than other western European nations. Countries such as the UK, France, Spain and Italy have reported 27,000 to 41,000 deaths. People have been asking how Germany has done it.
Well, Turkey has a population of 84 million, almost the same as Germany, and has reported 4,825 deaths from 179,000 confirmed cases, comfortably better than Germany even allowing for the fact that the virus arrived in Turkey later. As soon as a patient comes to hospital reporting symptoms, even before the covid-19 diagnosis has been confirmed by testing, the patient is administered with hydroxychloroquine and azithromicyn. Any complications are dealt with by other drugs, for example, favipravir for pneumonia, tocilizumab for cytokine issues or an anticoagulant for coagulopathy.
Thanks
sweden reviewed
ROFLMAO. See this data here? I wrote down a number and underlined it, solid, very solid.
My thoughts exactly. For someone who holds others to a high standard, Mosher doesn’t hold himself to any standard whatsoever.
WRT to Sweden, it’s too early to tell if their approach is right or wrong. We won’t know until the pandemic has run its course, which it will do until there is either herd immunity or a vaccine. There may never be a vaccine or it may take a long time to become widely enough available, so Sweden may well end up being right over the long term.
There have been numerous epidemiologists who have correctly pointed out that places that imposed strict lockdowns may well have gotten the virus under control (for however long), but in doing so, they did not achieve a sufficient level of herd immunity, so they are vulnerable to a resurgence. Countries like New Zealand, Denmark, Norway and Finland (among others) are examples. They will have to stay locked down until there is a vaccine, resulting in ongoing damage to the economy, massive unemployment, failure of businesses and unrestrained growth of debt.
The supposed original point of “flatten the curve” was to prevent overloading the healthcare system. There are countless pictures that show the height of the “flattened curve” just touching a line representing the capacity of the healthcare system. However, the goalposts kept getting moved further and further to point where many places (such as Vancouver) are very slow to relax the restrictions, despite very few new cases and despite never coming close to overloading the healthcare system. Sweden stuck with the original claimed point of flatten the curve. They have had more deaths than some countries, but they have not overloaded their healthcare system, so the criticisms are unwarranted.
But Sweden may look worse than it is, because according to the article below it, unlike its neighbors, includes deaths WITH Covid-19 as deaths FROM Covid-19.
————
“Sweden reports the number of people who die with COVID-19, not of COVID-19.
“Even in a culturally and geographically similar country like Norway—celebrated for its low death rate—they do things differently. The Norwegians only count something as a COVID-19 death if a doctor concludes that someone was killed by the disease and decides to report it to the country’s public health authority.”
https://reason.com/2020/04/17/in-sweden-will-voluntary-self-isolation-work-better-than-state-enforced-lockdowns-in-the-long-run/?utm_medium=email
In Sweden, Will Voluntary Self-Isolation Work Better Than State-Enforced Lockdowns in the Long Run?
There’s a lot of debate over the Swedish model of coronavirus response, but there are good reasons to think a Hippocratic approach to policy may pay off.
JOHAN NORBERG | 4.17.2020 11:50 AM
Maybe in the RECOVERY trial they even confused “Hydroxychloroquine” with “Hydroxyquinoline”:
https://twitter.com/JamesTodaroMD/status/1272542546758074369
Which would explain the dangerously high dose of 2400mg HCQ used on day one.
This whole sorry saga around these drugs that are saving lives will be a shameful burden the medical profession will have to carry for a long time.
Politics and big pharma working together for mutuel benefit, while tens of thousands of their own citizens denied BY LAW access to effective medicine is a truly abhorrent deed.
Hippocratic oath anybody?…….. ” I will prevent disease whenever I can, for prevention is preferable to cure”
Below is a link to an interview in Nexus magazine with Professor Christian Perronne Head of the infectious diseases department of the Raymond-Poincaré hospital just outside Paris.
It’s in french so you’ll have to chuck a google translate on the page, but he very clearly lays out his reasons for prescribing Hydroxychloroquine and Azithromycin.
https://www.nexus.fr/actualite/entretien/perronne-hydroxychloroquine/
Some excerpts:
Have you had positive clinical results in your department since you generalized treatment with hydroxychloroquine and azithromicyne?
Prof. Christian Perronne: It changed the situation. Even the doctors on duty and the nurses confirm that there are far fewer sick people in intensive care.
What do you have to answer to all those who prefer to wait for the results of the studies and bet everything on the academic methodology?
Prof. Christian Perronne: It is incomprehensible because, when they have the certainties, the final results, the epidemic will be over and everyone will be dead. We cannot pretend that we are in a time of peace….. but we have to move now! What do you care about having a placebo, a control group, if you heal a lot of people? Here we are in a war situation.
How many people have you prescribed this drug to in your entire career?
Prof. Christian Perronne: I have prescribed it to thousands of patients for 20 years. I had zero deaths. Sometimes I asked the advice of the cardiologist.
Out of the French text, an important part I found reading the French source::
Sensible bloke. If you have to amputate a leg on the battlefield you don’t wait for academics to find out what the approved way of doing it is. You just use what is at hand and give it your best.
Also out of the French text, for our “side-efect-hunters”
These studies seem to fail for one of two reasons: 1) There is a political or financial stake in the failure or 2) The “scientists” conducting the analysis don’t understand the two mechanisms by which HCQ is hypothesized to fight Covid-19.
The first of these two mechanisms is the raising of the intra-cellular pH which defeats the replication mechanism of SARS-Cov-2 which must lower the pH of the endosomes in order to replicate. This takes several days to accomplish and so is only helpful at presentation of first symptoms or as a prophylaxis begun days before infection.
The second is that HCQ (and to a much lesser extent chloroquine) is a zinc ionophore and zinc is a key inhibitor of the intra-cellular replication process. In past studies, HCQ has been shown to be 3 X more effective moving Zn through the cellular membrane as CQ, so treating them as equal treatments is wrong. Also, the studies so far do not supplement the HCQ administration with extra Zinc which is another requirement for moving Zinc through the cell membrane (duh).
If you are going to do a study on the efficacy of HCQ, at least take into account these basic facts about how it works and when to administer it. Don’t wait until someone is on the ventilator to give it to them and expect a positive outcome and don’t do bad science like the VA study that has been shown to have significant (p<.05) differences between the treatment groups in factors contributing to survival.
I hate to think what the human total of this bad and politically motivated science has been. (Not quite as high as the climate bad science, but still …)
Dexamethasone should be included with anti-coagulation drugs to treat COVID-19:
https://www.bbc.com/news/health-53061281
Dexamethasone is cheap and globally available. Its anti-inflammatory effects are most likely the ones mediating the benefit which is not an overwhelming surprise.
But it is still no “wonder drug” or “game changer” or a cure. It is significant in its benefit even for patients already on ventilators which is more than everything else so far (except anti-coagulants though the randomized control trial is still out).
It’s a steroid and used to treat the most severe cases, patients who are at death’s door.
Not surprisingly dexamethasone doesn’t work on people who don’t suffer from increased inflammation and don’t receive O2:
https://youtu.be/ie5Oi8m_Rlo?t=187
But the NNT is so low like with nothing else so far (except for anticoagulation but that is not out as a randomized controlled trial so far).
This should rack up the total deaths for what rational reason?
Lockdowns … vehemently opposed by The Left to take ’em down, all evidence of their futility notwithstanding.
Chloroquine … vehemently opposed by The Left as potentially dangerous. After 3rd decimal place.
Masks … originally vehemently opposed by The Left as unnecessary and potentially harmful.
I’m a scientist, both by profession and by nature.
In a pandemic, using fairly widely reported, but almost entirely empirical ‘novel treatment’ …
˙ is humane
˙ is warranted
˙ has potential for much greater general good, than general setback.
˙ must be handled expeditiously, to thwart morbidity
We’re in a strange new world, folks. A world where “doing anything at all to stop Trump” sets aside every pretense of scientific and rational thought. A world in which ever last crackpot conjecture to support this narrative is virally disseminated through most-every channel of social self-publishing. Copy, paste, copy, paste, forward, copy, paste.
I really didn’t believe a few decades back, that the human social sphere could be so egregiously misguided by its own vocal politically motivated activists. Down to the girl in the dorm next door, on her smart phone, texting to her VacuumBook page or InstantShit account, publishing to hundreds-to-thousands of others. Who do the same.
Madness!
We are in that kind of world.
Eric,
“IMPORTANT It appears the Guardian may have misinterpreted the actions of the FDA, or perhaps I misinterpreted what the Guardian was trying to say. It appears that doctors are now free to provide Hydroxychloroquine however they see fit.”
Pretty remarkable that this article and discussion can happen when there is said to be doubt about whether HCQ has been restricted or totally liberated. But the Guardian hasn’t misinterpreted. The FDA notification is here. It begins by explaining what an EUA is:
“Today, the U.S. Food and Drug Administration (FDA) revoked the emergency use authorization (EUA) that allowed for chloroquine phosphate and hydroxychloroquine sulfate donated to the Strategic National Stockpile to be used to treat certain hospitalized patients with COVID-19 when a clinical trial was unavailable, or participation in a clinical trial was not feasible. The agency determined that the legal criteria for issuing an EUA are no longer met. Based on its ongoing analysis of the EUA and emerging scientific data, the FDA determined that chloroquine and hydroxychloroquine are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA. Additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorized use.”
Doctors can prescribe HCQ if they want, in the same way they could prescribe valium or nexium. They just can’t say they are following FDA procedure or advice.
And considering that demand for HCQ is soaring and manufacturing is ramped up, seems like doctors all over the world are using it. Just not in places with the outlier death counts it seems.
“seems like doctors all over the world are using it”
Well, it means that enthusiasts like Gov DeSantis of Florida are buying it (1 million doses). But the doctors aren’t burdening their patients with it (only 20000 used).
Ther German news seem not to see too, that HCQ is now free without restrictions, just in contrast
When have the German news the last time reported adequately and true about anything in the US?
😀
PS to my earlier comment. I forgot to add this: https://www.bbc.co.uk/news/health-53061281?fbclid=IwAR0v0ciTTYIM_dFAlTBgtayzEYm-hWgbHc1VKsFadxEFtXkgV-y8FZqylfw.
Cheap, widely available steroid called dexamethasone can improve COVID-19 survival, researchers say
Researchers in England said they have the first evidence that a drug can improve COVID-19 survival: A cheap, widely available steroid called dexamethasone reduced deaths by up to one third in severely ill hospitalized patients.
Results were announced Tuesday, and researchers said they would publish them soon. The study is a large, strict test that randomly assigned 2,104 patients to get the drug and compared them with 4,321 patients getting usual care.
The drug was given either orally or through an IV. After 28 days, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those needing only supplemental oxygen. It did not appear to help less ill patients.
“This is an extremely welcome result,” one study leader, Peter Horby of the University of Oxford, said in a statement. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf and can be used immediately to save lives worldwide.”
“Dexamethasone must now be rolled out and accessed by thousands of critically ill patients around the world,” said Cammack, who had no role in the study. “It is highly affordable, easy to make, can be scaled up quickly and only needs a small dosage.”
Steroid drugs reduce inflammation, which sometimes develops in COVID-19 patients as the immune system overreacts to fight the infection. This overreaction can prove fatal, so doctors have been testing steroids and other anti-inflammatory drugs in such patients. The World Health Organization advises against using steroids earlier in the course of illness because they can slow the time until patients clear the virus.
https://eu.usatoday.com/story/news/health/2020/06/16/coronavirus-drug-steroid-dexamethasone-reduce-covid-deaths/3197420001/
The BBC is also promoting this but when one looks closer at the stats they do not seem as impressive as the headlines.
https://www.bbc.com/news/health-53061281
Surely they are addressing the wrong question.
“If you are already infected, will HCQ + zinc cure you”.
This is like showing that if you have a flu shot when you already have the flu, that it does not help”.
The proper question should be.
“If you do not have malaria or COVID-19 and you take HCQ and zinc, will it help you in preventing a severe
infection?”
You could also make tea out of Cinchona Bark, or let the bark seep in gin or rum. This apparently works well against plasmodium.
Queen Elizabeth the Queen Mother used to swear by a good Gin and Tonic -” it’s always 5 o’clock somewhere in the empire!”
Suffice it to say, the case against HCQ has been built in similar fashion to the case against CO2, or “carbon”. It is one built on ignorance, politics, lies, pseudo-science, and of course, money.
Add corruption and conflict of interest.
I get the same perception.
Unless the law has changed, in California, a doctor could provide any licensed drug for any purpose, with the exception of controlled substances.
Is there a California MD who can confirm this?
FWIIW, much like HCQ controversy, there has never been a randomized, double-blind, placebo controlled study of the effectiveness of many interventions. For example, parachute usage, to overcome gravitational challenge, has _NOT_ been studied in a medically rigorous and scientific manner!!!
Although details are at the link (https://www.bmj.com/content/327/7429/1459.full); the core message is that “As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.”
Almost forgot … heavy dose of sarcasm with tongue firmly in cheek (grin ^ grin)
From the FDA announcement … “Of note, FDA approved products [i.e. HCQ] may be prescribed by physicians for off-label uses if they determine it is appropriate for treating their patients, including during COVID.” … in other words, an MD can still prescribe HCQ for whatever reason the MD wants to
I forsee a sudden plague of suspected lupus cases breaking out all over the country. And malaria. You can never be too careful about malaria.
So what should I take if I get COVID-19? I’m 73 years old, and would rather not cough my lungs out. I read somewhere that Pepsid AC may be beneficial, and more recently, another commonly used drug, but I can’t remember its name. For me, my favorite “magic bullet” I use when I start getting sick is diphenylhydramine (the active ingredient in Benadryl). I don’t have allergies, but if I take the maximum dose at the onset of cold symptoms, or other sicknesses, it seems to have a very beneficial effect. And it doesn’t make me sleepy.
Littlepeaks, Watch the video. Call your representative.
This is an interesting update of Dr Zelenko’s progress in getting his data for the HCQ with Zinc Sulfate treatment of Covid ill patients published. Zelenko has treated more than 700 of his sick patients with HCQ and Zinc Sulfate.
Independent peer reviewed studies have shown the HCQ is a zinc ionophore (it enables a tiny amount of the Zn+2 ions into our cells and the Zn+2 ions have been shown to stop covid from connecting to the ACE-2 connector molecule in our cells and replicating.
Two established, senior, German researchers have connected Zelenko and are directly working with Dr Zelenko to help him publish his results.
P.S. Vitamin D deficient people have been shown to have a 19 times greater chance of dying from Covid or having serious covidn symptoms, as compared to vitamin D normal people. 4000 UI/day is required to correct the Vitamin D deficiency. A glass of milk has 100 UI in it. This finding explains why UK Black people are three times more likely to die from covid than white people. The death rate for covid correlates with how dark the patient’s skin is, as their severity of their Vitamin D deficient also correlates with the severity of their vitamin D deficiency. (See my comment above for details and links to peer reviewed papers.)
Thanks for the reply Ashley. I still go to a military treatment facility (I was grandfathered in) for health care, and I’m not sure if they have any restrictions for treatment. I do know that the post is paranoid about covid-19. I’ve been tested for vitamin D, and have plenty. I think part of it is that I spend a LOT of time outside in the sun, even in the winter.
“Two established, senior, German researchers have connected Zelenko and are directly working with Dr Zelenko to help him publish his results.”
I suspect that he, like many so-called “local MDs”, is not well-positioned to write “studies” or even papers, that journals will accept. Hospital-based MDs are much better-positioned. Their duties are partly administrative. They have a “secretariat” in effect that can collect statistics. They have a larger number of patients on whom to collect statistics. They can often control the environment of the patient in a way that an out-patient doctor cannot. They can more easily and accurately measure patients’ statuses day-by-day. Their “affiliation” gives them “cred.” Their employer is more likely to encourage them to produce papers.
Since hospitalized patients are the ones who benefit least from HXQ, but hospital-based doctors are the ones positioned and motivated to write studies, that would seem to explain why HXQ studies so far are not encouraging.