tag:blogger.com,1999:blog-7655407863660711763.comments2023-04-13T15:43:17.917-04:00Billy Rubin's BlogBilly Rubinhttp://www.blogger.com/profile/04850166742797443954noreply@blogger.comBlogger247125tag:blogger.com,1999:blog-7655407863660711763.post-48106857156855488172020-08-02T08:10:36.817-04:002020-08-02T08:10:36.817-04:00Thank you for your candid evaluation, Unknown. It&...Thank you for your candid evaluation, Unknown. It's "Doctor Rubin," however.Billy Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-39043837129221737702020-08-02T04:19:05.347-04:002020-08-02T04:19:05.347-04:00I started to take serious consideration that this ...I started to take serious consideration that this guy might have some character and knowledge to what he says until the Trump business started and then he showed himself as a obvious prejudice to Trump because he is a president that dont follow the political money hungry norm but instead asks questions of "why don't we"? After that all these politicians and their big money financiers, that are butt hurt because the people voted Trump in and not the criminal Clinton, pull everything they can to discredit anything that could benefit this country. And that includes hurting the people. You and your Blog are a joke mister Rubin. You call Dr. Zelenko simple. Well sir your way of trying to push whatever agenda you have has made you look like the simplest of all. Obviously you and your Liberal buddies will do anything to discredit any and all information that could be beneficial to the people, all so a President you don't like will look bad. The majority is smarter than you give us credit for. You will lose at your own cruel game. To end on a note back on the original topic, there are numerous professionals out there' that carry themselves more professional than you, saying opposite of what you dish out. I'm going to, along with the majority in this country, believe their opinion over yours just by the way they professionally carry themselves. They don't pack around a political agenda with what they say. Its a shame the liberal politicians and big money that finance them have key people in there pocket to keep this data looking bad. But it cant stay forever in the dark. The truth always comes out. Anonymoushttps://www.blogger.com/profile/02463188497118129343noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-63262200075274510022020-05-16T19:38:24.406-04:002020-05-16T19:38:24.406-04:00Thanks for the feedback, anon. Funny it should com...Thanks for the feedback, anon. Funny it should come today, given this headline in the Washington Post: "hydroxychloroquine, , an anti-malarial drug President Trump encouraged as a treatment for covid-19 patients, is not only ineffective but significantly increases the risk of death for some, new evidence suggests. <br /><br />“Alarmed by a growing cache of data linking the anti-malaria drug to serious cardiac problems, some drug safety experts are now calling for even more forceful action by the government to discourage its use,” The Post reported. Read about how some of those experts are calling for the Food and Drug Administration to revoke the emergency authorization it granted for use of the drug during Trump's sales pitches."Billy Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-76326060468892027662020-05-16T16:07:13.409-04:002020-05-16T16:07:13.409-04:00I think ideology is clearly interfering with your ...I think ideology is clearly interfering with your role as a physician. I only hope your patient's family and love ones find this blog before is too late.<br /><br />Time will tell who the real "doofus" is. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-3952106762094795702020-05-09T06:03:45.189-04:002020-05-09T06:03:45.189-04:00You hit the nail on the head, Billy. Death toll is...You hit the nail on the head, Billy. Death toll is faked #s to get rid of trump. https://www.nytimes.com/2020/05/09/us/politics/coronavirus-death-toll-presidential-campaign.html?action=click&module=Top%20Stories&pgtype=HomepageEric the Shrinkhttps://www.blogger.com/profile/18064319144677555590noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-81766436922364166272020-05-07T21:56:01.120-04:002020-05-07T21:56:01.120-04:00So, Billy, if I'm reading you right me recentl...So, Billy, if I'm reading you right me recently stocking up on my cat's insulin syringes and the bleach I bought last weekend at Home Depot may not help?Eric the Shrinkhttps://www.blogger.com/profile/18064319144677555590noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-48274520486819988112020-05-04T14:57:16.976-04:002020-05-04T14:57:16.976-04:00What's amazing is the magical thinking of the ...What's amazing is the magical thinking of the speed and painlessness of here immunity. .flyover country by June. Sweden in 2 weeks. I want some of what they're smoking...Eric the Shrinkhttps://www.blogger.com/profile/18064319144677555590noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-83706638819170192812020-05-03T14:52:52.141-04:002020-05-03T14:52:52.141-04:00I was with you until you misidentified Karen Carpe...I was with you until you misidentified Karen Carpenter.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-67402877870843542742020-05-03T12:50:02.088-04:002020-05-03T12:50:02.088-04:00"Hopefully mechanical engineers are more prec..."Hopefully mechanical engineers are more precise." <br />A popular Mech Eng design program is "AutoCad"; someone had a sense of humor in the menu where you get to select the units you want to work with (my thanks to Sara Falcone): https://tinyurl.com/y9nqlruo David Ihttps://www.blogger.com/profile/11594073847104751191noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-66236766612089010152020-05-02T14:39:00.762-04:002020-05-02T14:39:00.762-04:00We "know" that's an undercount. Wha...We "know" that's an undercount. What you "know" ain't exactly "so". Compare 2019 deaths from 2020 deaths for NY. What we actually know is that there is a high degree of uncertainty. Sloppy thinking.<br /><br />People keep saying that covid is coming to my area of flyover country, but our new infections have been flat for a month and our random swab sample showed almost 4% infections. I figure we're at 16% who have or have had covid. Herd immunity by end of June.theasdgamerhttp://theasdgamer.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-62965960077432823412020-04-24T11:19:00.606-04:002020-04-24T11:19:00.606-04:00Billy, the web counters right now (4-24-2020 at 11...Billy, the web counters right now (4-24-2020 at 11 am EDT) are reporting about 50.4k deaths directly from covid. We know that's an undercount, but any guess on exactly how under it is? Or is this a "they'll figure it out in 5 years when all the dust settles" type situation?Eric the Shrinkhttps://www.blogger.com/profile/18064319144677555590noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-30237839827253721682020-04-21T05:53:15.181-04:002020-04-21T05:53:15.181-04:00That's a lie. He would had someone else stab t...That's a lie. He would had someone else stab the researcher while both denying it happens while asserting his right to stab. He would have eaten the entire bag of marshmallows right there and demanded 100 more before leaving. Eric the Shrinkhttps://www.blogger.com/profile/18064319144677555590noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-10777282978018540352020-04-18T00:46:43.658-04:002020-04-18T00:46:43.658-04:00I do enjoy your blog. I'm not offended. I...I do enjoy your blog. I'm not offended. I'm not an expert although I can dive pretty deep. And my daughter has listened and generally agrees with my analysis. But she's a clinician and not an academic. Art v. science.<br /><br />I KNOW that docs are using HCQ/zinc all over the country--from Utah to Memphis Tennessee to Kiryas Joel. As one doc told me, EVERYBODY is using HCQ. But not everybody is using zinc with it, although perhaps patients are dosing themselves with zinc on the QT, so maybe that makes HCQ monotherapy look better than it deserves.<br /><br />Here are suggestions from Utah Health Dept. about treatment for covid:<br /><br />https://coronavirus.utah.gov/wp-content/uploads/Treatment-Suggestions-for-COVID19rev.pdf<br /><br />Utah has pretty good nos. Low fatality rate. May it never be, but if someone you loved were seriously ill with covid, would you dose them with HCQ/zinc?<br /><br />I don't think that Zelenko cares about looking professional. He has definitely had an impact on doctors across the country. If Zelenko has saved thousands of lives, that ain't just peanuts.<br /><br />At least we agree that a study would be good. Zelenko probably couldn't get published even if he actually did a study. Politics play a major role in science publishing, of course. Maybe I'll talk to my daughter about doing one. She's done quite a lot of research in the past. Even though she's a clinician. And maybe I'll help her.<br /><br />The risk from Plaquenil using Zelenko's treatment is nil for 99.9% of patients. What would I give? 5 days 200 mg Plaquenil bid, but I lose the zpak. I would keep the 220 mg zinc gluconate qid (or maybe 110 mg bid) for five days as well. (110 mg zinc gluconate bid is easier on the stomach.)<br /><br />I'd try an arm with vitamin C and one with vitamin D and one with both and one without either vitamin. I'd look for data where nothing had been prescribed and one where HCQ monotherapy had been used.<br /><br />I'd look for both ideal patients and non-compliant patients.theasdgamerhttp://theasdgamer.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-7726578809974674912020-04-17T20:58:49.284-04:002020-04-17T20:58:49.284-04:00I personally have been digging the new Burger King...I personally have been digging the new Burger King fake Whoppers, so there is no beef. And if you put bacon and cheese on it you're cancelling out the trayf. Eric the Shrinkhttps://www.blogger.com/profile/18064319144677555590noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-40746279720602605082020-04-17T20:54:26.082-04:002020-04-17T20:54:26.082-04:00Billy, you also missed the subtle racism comparing...Billy, you also missed the subtle racism comparing the every so compliant/adherent Chasidim vs "inner city." <br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-38991715416922644702020-04-16T16:15:02.669-04:002020-04-16T16:15:02.669-04:00I think what you've written is nonsense, Gamer...I think what you've written is nonsense, Gamer. Sorry to be blunt, as it's always nice to see someone mathematically ept enough to understand a normal distribution and run a power calculation, but our fundamental disagreement revolves around the fact that you believe the "data" of a guy who goes on YouTube to share his results, and I don't, because no professional worthy of his or her salt would communicate such momentous findings in this way. <br /><br />And patients lives are on the line, which is why you don't potentially kill them with medications that you don't know work. Running a clinical study when thousands of patients are infected isn't *that* difficult. So please spare me your platitudes about "combat medicine."Billy Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-13124168050964979452020-04-16T14:31:01.825-04:002020-04-16T14:31:01.825-04:00Medicine is an art as much as it is a science. Ma...Medicine is an art as much as it is a science. Maybe more. So you have to watch patients carefully with a novel disease like corona. And you have to be ready to switch from academic medicine to medicine based on critical thinking--the Arthur Conan Doyle variety of medicine. Zelenko is pretty good at it--I watched his video as he explained his thought process.<br /><br />Covid is not a typical ARDS disease for many patients--more like high altitude sickness or malaria. I'm basing this on what I read that ER docs write.<br /><br />I ran the numbers for Zelenko's results. I assumed a more conservative mortality rate than you did in order to give the placebo a better chance--2% mortality.<br /><br />Assuming normal distribution, Zelenko should have had 13-14 deaths. He had zero. So what were the odds of that?<br /><br />((0.98)exp699)exp13 = nil. below the resolution of the calculator.<br /><br />If we assume a mortality rate of 4%, the numbers are even better for Zelenko. And with zero intubations, MUCH better.<br /><br />But maybe Zelenko is lying or not reporting negative outcomes. Zelenko's patients come mostly from Kiryas Joel. Kiryas Joel is high profile now. Everybody can find it on the map. Even news reporters. I'm sure none of them would want to embarrass Zelenko and Trump by showing that Zelenko's regimen had failed for some patients. <\sarcasm> The village elders of Kiryas Joel have publicly flamed Zelenko for making the village high profile. What are the odds that they wouldn't out Zelenko if some of his patients had died? So, at least for the first two week cohort of Zelenko's patients--they probably recovered.<br /><br />I assume that the patients of Kiryas Joel and the nearby town where Zelenko gets his other patients are highly compliant with his regimen. That's not necessarily the case for inner city patients, with their frequent distrust of physicians, lack of a basic understanding of medicine, lack of resources, tendency to go AMA, etc. So, with a cohort from the inner city, you would likely see some deaths.<br /><br />Zelenko's focus is clinical, not academic. He's not concerned with publishing, but with treating patients. I'm sure someone who is academically inclined will get around to interviewing Zelenko and looking at his data. It might be an important paper.<br /><br />I get it that confirmed double blind peer reviewed clinical trials are the gold standard of academic medicine. That standard trumps anecdotal evidence. But patients' lives are on the line as we wait for a gold standard treatment protocol. Combat medicine is required while the gold standard is being pursued.<br /><br />I heard a story about a fire at a university. Some coeds were trapped. Snow had blocked the roads and the firetrucks couldn't get through. Some maintenance guys had found some old milk pails in the basement of one of the buildings. The professors debated using the milk pails, but ultimately rejected using them because there were no confirmed double blind peer reviewed clinical trials proving that the pails were effective at fighting fires. The coeds suffocated. --Gamertheasdgamerhttp://theasdgamer.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-88238834378273208452020-04-15T10:24:01.564-04:002020-04-15T10:24:01.564-04:00LOVE the turtles simile here! So very true.LOVE the turtles simile here! So very true.Billy Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-74278404603179642212020-04-14T16:29:14.399-04:002020-04-14T16:29:14.399-04:00Trump is a simple man who requires simple explanat...Trump is a simple man who requires simple explanations for complex problems. He picks one idea and runs with it, and his fanboy base laps up whatever the says. Before plaquenil, it was something else/some piece of drivel without a shred of evidence that he repeated ad nauseam, and so on. There's basically turtles all the way down.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-56696711197051570442020-04-14T15:41:28.412-04:002020-04-14T15:41:28.412-04:00I gave a somewhat testy reply about Zelenko on the...I gave a somewhat testy reply about Zelenko on the previous blog post that is devoted exclusively to hydroxychloroquine. I apologize the slightest bit for the testiness, but not for holding Zelenko in contempt for utter irresponsibility. I've tried to explain in this post and the previous one why his claims should be greeted with absolute skepticism, and why stuff like this, where the phrase "DO NOT TRY THIS AT HOME" should be flashing to every doctor who thinks they want to experiment on their patients with some kitchen-counter concoction because they read about some study in France that "was intriguing." (I don't know if Zelenko used those precise words, but it conveys the general gist.) <br /><br />The fact that he mentions the French study is the tell that he's a rube and just got suckered. Every doctor worth a damn who knows something about clinical trial design didn't even laugh when they looked at that study, their jaws dropped as they said to themselves--and anyone else who would listen--"you mean to tell me someone as famous a Didier Raoult put his name to THAT? What the fuck's the matter with him?!" Now you may not know who Didier Raoult is, but in the world of infectious disease medicine, he's about as famous as it gets--only Paul Farmer and Anthony Fauci have greater fame off the top of my head. But this "study" is an embarrassment, and he should never have done anything as irresponsible as lend his name to this. I assure you that I am not alone in that assessment. It's simply not controversial. Nobody who understands clinical trial design thinks this is worthy of attention, and as such it's worse than armchair speculation because people like Zelenko hear the word "study" and think that, even if it isn't *perfect,* the results *might* be telling us something. But they don't. And the fact that he hasn't the foggiest clue about that should provide strong circumstantial evidence why we shouldn't swallow his claims about these pills, so to speak.<br /><br />Zelenko mentions a paper from South Korea. Here is a review paper from March 22 that looks at most or all existing studies of chloroquine and hydroxychloroquine, and mentions a trial there, the results of which do not appear to have been published yet. This paper itself is not peer reviewed, so use at your own risk, but its conclusion is that we are nowhere close to knowing whether either of these drugs work: https://www.medrxiv.org/content/10.1101/2020.03.22.20040964v2.full.pdf.<br /><br />I've never heard of "Cardillo in LA," but I would guess this is the same phenomenon, and I've no interest in playing Dumb Doc Whack A Mole. <br /><br />There are now millions of people infected, so if people with time on their hands want to do a trial of Plaquenil and Zinc, they can be my guest. The likelihood that it won't show benefit is extremely low, somewhere between zero and two percent, if you're being optimistic, and if it's conducted properly. MOST drug trials fail, even ones whose rationales are better than the reasons supporting hydroxychloroquine.Billy Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-91222344856160694072020-04-14T15:22:00.584-04:002020-04-14T15:22:00.584-04:00Zelenko is a guy who posted on YouTube that he tre...Zelenko is a guy who posted on YouTube that he treated 700 patients. This isn't how formal medicine operates; it's not a fucking souk where you're reliant on half-baked claims that aren't properly documented. You don't "publish" your results on YouTube (https://www.youtube.com/watch?v=m3J_1B7kJbk). You document data carefully in terms of primary outcome (eg death) and secondary outcomes (hospitalization, length of stay, days of fever, average white blood cell count, average blood pressure, and the list goes on). You carefully separate groups into cases and controls who get fake pills called placebo; you blind yourself to knowing whether you're giving a real drug or a placebo, and when you create the groups, you don't use language like "which I judged to be high risk" (listen to just after the 5-minute mark) without explaining your criteria for judgement. You take care in statistical analysis to make sure there aren't reasons for potential differences. You design the study with the input of an ethics board. But sorry to be picky, kind of goes with my analytical bent. <br /><br />I'm not a statistician so I can't do power calculations in my head, but you are right that 700 patients would constitute a large enough group to study properly. So study it properly, Doctor Zelenko, like the rest of us good boys and girls who follow the rules of scientific evidence, and then get back to us.--BillyBilly Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-9107016990645335212020-04-14T15:03:57.366-04:002020-04-14T15:03:57.366-04:00Never poke a Yiddish bear.Never poke a Yiddish bear.Billy Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-104434164976638202020-04-14T10:33:38.791-04:002020-04-14T10:33:38.791-04:00"This blog entry, despite running to thousand..."This blog entry, despite running to thousands of words, hasn't even taken a shot at explaining a heart-stopping effect called the long QT syndrome, which is almost certainly hydroxychloroquine's most deadly acute effect"<br /><br />Do you know of some acute studies on 200mg Plaquenil bid for 5 days? What is the risk of cardiac arrhythmias in lupus patients after ten years?<br /><br />"With a four percent case fatal virus, you cannot see what sticks unless you do a clinical trial."<br /><br />Four percent for those patients who are 60+ or are hypoxic? There is an error of distribution in your statement. With 700 patients taking his regimen, Zelenko should see some intubations and deaths if his treatment is no better than a placebo.<br /><br />Sorry to be picky. :) Kind of goes with my analytical bent.<br /><br />theasdgamerhttp://theasdgamer.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-57213676997294017312020-04-14T10:19:12.512-04:002020-04-14T10:19:12.512-04:00Thanks for replying.
Zelenko says that he has tre...Thanks for replying.<br /><br />Zelenko says that he has treated 700 patients with zero deaths. And he only treats patients with hypoxia or if they are 60+. Zelenko says that early treatment with his regimen is critical. Zelenko states that he found a South Korean paper which covered a trial using HCQ/zinc, but I haven't been able to find it. Perhaps you have?<br /><br />What are the odds of zero deaths with those facts?<br /><br />Then there's Cardillo in LA who reports that he gives HCQ/zinc to patients who are "severely" ill and sees remission of symptoms in 8-12 hours.<br /><br />Best wishes to you and your patients.<br /><br />I would LOVE to see a clinical trial of HCQ/zinc, whether it disconfirms or confirms.theasdgamerhttp://theasdgamer.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-41917320443293862962020-04-14T10:19:05.739-04:002020-04-14T10:19:05.739-04:00At the risk of triggering a 'BillyRubin storm&...At the risk of triggering a 'BillyRubin storm' (a.k.a. 'poking the bear'), dare I ask about the trial being run in South Dakota? :-)David Ihttps://www.blogger.com/profile/11594073847104751191noreply@blogger.com