 |
 |
Hi Kumara, Let’s assume the Lancet study is flawed, does this really justify giving Rx with unknown benefits and well known harms? That is, regardless if the study described in the Lancet is credible or not, what EBM has taught us is that the probability of harming patients when giving them not well tested treatments is much higher than benefited them (+ lead to waste of resources). On my last count, there are 30+ different treatments that have been claimed to have effect against SARS-CoV2 (from vitamin C to HCQ to plasma of patients who recovered from COVID19). Should we use them all? This urge “to do something”, to “treat ourselves rather than patients”, or even to provide false hope is , unfortunately, characteristic of all physicians regardless where we practice. But, we ought to resist it. Or, better, we should use the opportunities like these to formally test the effects of these Rxs. For example, perhaps you have enough patients treated with HCQ that you can analyze and we all can learn from you. This is not criticism of your practice- tendency for overRx dominates the current practice of medicine all around the world- but I am sad to see that after more than quarter century EBM is still In its infancy. Thanks for openly engaging about your practice - only by sharing our experience we can learn from each other Best Ben Sent from my iPad - excuse typos and brevity On May 25, 2020, at 11:56 PM, Kumara Mendis <[log in to unmask]> wrote: Hi Ben I guess when you have no treatment at all fir Covid and you have a lots of experience with using Chloroquine for Malaria you want to do something fir your patients Patients will also be happy to know that they are getting some specific medications This is exactly the situation in most of the LMI countries Isn’t it not how most of the treatments for diseases have come about? But now with this Lancet study things take a different turn We have done evidence of the efficacy of the treatment My question is how good is the study to inform us and can it be generalized ? Thanks Kumara On Tue, May 26, 2020 at 8:38 AM, Benjamin Djulbegovic MD <[log in to unmask]<mailto:[log in to unmask]>> wrote: The question is, Kumara Why would you administer HCQ with or without macrolides to begin with? [Just because there is no effective Rx is not good reason “to try something”. ] Ben Sent from my iPad - excuse typos and brevity On May 25, 2020, at 7:15 PM, Kumara Mendis <[log in to unmask]<mailto:[log in to unmask]>> wrote: ________________________________ [Attention: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails.] ________________________________ Dear all In Sri Lanka everyone who is admitted to the designated hospitals with PCR+ COVID gets at least Chloroquine /HCQ The Lancet has published a study Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis The findings are : We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19. Has anyone done a critical appraisal of this paper? My question if you are a clinicians would you give HCQ and or macrolide to each and every person (I will add my own criteria after taking an ECG and if there is no abnormal changes of rhythm or other ischaemic changes) Would much value your comments Thank you Kumara Truth, wisdom, learning, and good sense—these are worth paying for, but too valuable for you to sell. Proverbs 23:23 ________________________________ To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following link: https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1<https://urldefense.com/v3/__https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1__;!!Fou38LsQmgU!91jd7V3XRwqcwMSR_gkLjwNXBUTfNIX7maOqJggNWH_KsBq_i01BjcHLG3Y65bpegQ$> ________________________________ ------------------------------------------------------------ -SECURITY/CONFIDENTIALITY WARNING- This message and any attachments are intended solely for the individual or entity to which they are addressed. This communication may contain information that is privileged, confidential, or exempt from disclosure under applicable law (e.g., personal health information, research data, financial information). Because this e-mail has been sent without encryption, individuals other than the intended recipient may be able to view the information, forward it to others or tamper with the information without the knowledge or consent of the sender. If you are not the intended recipient, or the employee or person responsible for delivering the message to the intended recipient, any dissemination, distribution or copying of the communication is strictly prohibited. If you received the communication in error, please notify the sender immediately by replying to this message and deleting the message and any accompanying files from your system. If, due to the security risks, you do not wish to receive further communications via e-mail, please reply to this message and inform the sender that you do not wish to receive further e-mail from the sender. (LCP301) ------------------------------------------------------------ -- Kumara Mendis MBBS, MD (Family Medicine), MSc (Medical Informatics), FCGP, FACHI Chair Professor of Family Medicine Faculty of Medicine University of Kelaniya Sri Lanka Tel: +942961245 | Mobile: +94776794423 | Web link<https://urldefense.com/v3/__http://medicine.kln.ac.lk/depts/fmed/prof-kumara-mendis.html__;!!Fou38LsQmgU!7Dzjjt-h0--fJr1UK9vYGta5QHGCYNRFCPf-cSjoeBZGSuSXcpZVLO701t7UxHauvA$> Associate Professor School of Medicine Western Sydney University Australia Web link <https://urldefense.com/v3/__https://www.westernsydney.edu.au/staff_profiles/uws_profiles/associate_professor_kumara_mendis__;!!Fou38LsQmgU!7Dzjjt-h0--fJr1UK9vYGta5QHGCYNRFCPf-cSjoeBZGSuSXcpZVLO701t57kSumNw$> Truth, wisdom, learning, and good sense—these are worth paying for, but too valuable for you to sell. Proverbs 23:23 ######################################################################## To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following link: https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 This message was issued to members of www.jiscmail.ac.uk/EVIDENCE-BASED-HEALTH, a mailing list hosted by www.jiscmail.ac.uk, terms & conditions are available at https://www.jiscmail.ac.uk/policyandsecurity/