Professor Risch Responds to Dr Rushworth over Hydroxychloroquine Post

Professor Harvey Risch responded today to a post by Sebastian Rushworth M.D., a physician in Stockholm, Sweden, who maintains a popular blog on C19.

The post titled “Hydroxychloroquine for covid: Lifesaving or useless?” presents an analysis concluding that:

“the evidence that exists at the present point in time does not support the use of hydroxychloroquine as a treatment for covid.“

Even the use of the drug is dismissed for early treatment, in combination with other agents such as Zinc or Azithromycin, as Dr Rushworth states:

“There is a signal that hydroxychloroquine could potentially decrease the risk of serious illness when given within three days of symptom onset, but there still isn’t enough trial data available to know whether that signal is real or not.”

In his post, Dr Rushworth dismisses the peer reviewed study by Derwand, Scholz and Zelenko, about the outpatient practice of Dr Zelenko during the beginning of the pandemic in NY State, showing a considerable reduction in hospitalization thanks to outpatient treatment, and which we covered in detail in this webinar.

The full posting by Dr Rushworth, whom we previously interviewed about the C19 situation in Sweden, can be found here.

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Below is Professor Risch’s response, initially posted on a discussion forum, and reproduced with permission. It is presented here not to stir controversy but to illustrate how the dismissal of observational studies still continues, with as consequence the rejection of the effectiveness of hydroxychloroquine, including for outpatient use.

You may remember our landmark interview with Professor Risch form last October.

Remember also we stressed recently how observational studies are dismissed by Stanford Professor Ioannidis, on the occasion of a recent videoconference he gave to Professor Didier Raoult and colleagues at the IHU-Marseille, where some 11,000 outpatients have received hydroxychloroquine-based treatment, with very low mortality.

Here is the response by Professor Risch:

“Sebastian, you do not understand epidemiology and have no professional expertise in epidemiology. You are not qualified to assert that “observational studies are rife with confounders” and dismiss a whole literature (if not a whole discipline) as supposedly flawed. You appear to know nothing about the body of work comparing randomized vs nonrandomized studies of the same associations. This massive body of evidence, summarized by the Cochrane Library, demonstrates that well conducted observational studies on average produce very similar associations as the corresponding RCTs. Treating RCTs as gold-standard evidence is naive and blind to the multitude of easy, hidden ways that RCTs can be and have been sabotaged to produce null or even opposite results.”

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“As a clinician, you should know that Covid-19 outpatient disease is viral replication, vs hospitalized disease which is florid pneumonia. These are absolutely different conditions and studies of the treatment of one cannot be extrapolated to the treatment of the other. Furthermore, studies of prevention (before infection) must also be kept separate from treatment, and so-called PEP post-exposure prevention studies are largely bogus altogether, because of the delays in patient recruitment, randomization, medication shipping and, most importantly, how long it takes to obtain adequate tissue levels to combat viral replication. Empirical data of the last-mentioned are available from 5 trials in India, and show that it takes a cumulative oral dose of 2-2.4 gm which none of the PEP studies delivered in less than 3-4 additional days, making them studies of early treatment, not prevention, but with almost no salient endpoints.”

“You, like most academic physicians, appear never to have treated any Covid-19 outpatients. You are out of touch with the fact that dozens of clinicians in the US have now cumulatively saved the lives of at least 10,000 high-risk patients. You can poo poo all you like. Docs on the front lines know better than you, they see it everyday.

Harvey A. Risch, MD, PhD
Professor of Epidemiology
Yale School of Public Health

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PS; Following Professor Risch’s critique, Dr Rushworth doubled down with his dismissal of observational trials: “I think there are enough randomized trials that the observational data can be disregarded.” he wrote in response to a question on his discussion forum. Unlikely Dr Rushworth would get a degree in epidemiology from Yale!

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