Paxlovid for Long Covid ?!
Results may vary ...
Paxlovid for Long Covid:
Results may vary …
In another sign that the narrative is both alive and well … yet crumbling, I refer you to an article I came across while catching up on my specialty-specific literature. An article in (the ‘throw-away’) Emergency Medicine News entitled Now for Something Completely Different: Paxlovid for Long COVID by Matt Bivens, MD caught my attention. It’s from the April 2024 edition … sorry I’m a little behind (but all caught up now).
Spoiler alert: it is a devastating takedown of the stupidity of the entire idea.
I will summarize for your enjoyment.
The article is off to a great start with the following: “We know two things about the antiviral elixir Paxlovid: It makes everything taste terrible …. It’s rapaciously priced: five times more expensive per gram than gold. …
What we don’t know - still - is whether this is a useful medication.”
The article does note that the New York Times (the last word in science, I suppose) has enthusiastically labeled the drug as “stunningly effective in preventing severe illness and death.” The newspaper of record cited a single observational study as proof of their conclusion. This article notes “It was also associated with having access to a doctor, to mention one stunningly effective confounder.”
The Cochrane collaborative did a bit more in depth evaluation and concluded that the drug “may” prevent some deaths and hospitalizations based on ‘low certainty evidence,’ a much less ringing endorsement. Hold on, we haven’t yet gotten to ‘long COVID.’
Somehow, the NYT also managed to miss the high rate of rebound after taking the drug (remember Fauci and others who reportedly experienced this). The study that reported on this unfortunate problem of course had to insert the mandatory ‘but.’ “Paxlovid remains a lifesaving drug.” Dr. Bivens points out the obvious: “Everything from an aspirin to a Z-Pak can be “lifesaving” in the appropriate context, yet somehow it’s always shrilly insisted upon for Paxlovid.” And… “the only randomized trial evidence that Paxlovid is “stunningly effective”... or “lifesaving” (CDC) comes from one study, EPIC-HR. … That landmark publication was Pfizer-run, start to finish, an appalling conflict of interest. Pfizer would go on to sell $18.9 billion worth of Paxlovid that year.”
Bivens goes on to point out the teensy weensy problems with that study, likely manipulated to fit the results desired. “EPIC-HR enrolled 2246 unvaccinated, high-risk, coronavirus-naive patients who started Paxlovid or placebo within five days, but then, without explanation, only analyzed those treated within three days. Paxlovid reduced hospitalizations felt to be caused by COVID-19, a troublingly subjective concept, and reduced mortality by 1.3%.”
But wait, there’s more!
The good folks at Cochrane found other studies. Only two were of ‘high quality.’ But there were others. Many of these were also Pfizer-backed. “Three more - EPIC-HOS, EPIC-SR, and EPIC-PEP - are all large studies operated by Pfizer, and they were completed or terminated but either way had gone radio silent. For those keeping score, that’s one positive study, EPIC-HR against at least 17 studies that were negative …, ongoing, or in limbo at Pfizer.” I tried to track down any late breaking results from these EPIC studies and could only find that the results are non-existent or that they showed no statistically significant positive effects.
You and I can figure out that finding a single study to promote a drug and ignoring the rest of the evidence is at best bad science and at worst manipulated data. I submit that this is standard practice these days and our regulatory agencies are, to all appearances, perfectly fine with it.
Dr. Bivens points out that “Cochrane launched a years-long campaign to drag additional data about Tamiflu into the public domain, exposing in the process how corrupted and broken the evidence-based medicine project had become. It’s thanks to Cochrane that we now know that Tamiflu doesn’t really prevent hospitalizations or complications, but certainly does increase vomiting, diarrhea, and psychiatric symptoms.”
Somehow governments are still stockpiling that drug much as they have done with the mRNA shots.
Finally, that brings us to the “stunningly effective” drug being touted for long COVID. “Yes, a medication reliably known to prolong a COVID illness is now touted to prevent a prolonged COVID illness.”
“Two large observational studies, including one of 9500 veterans, found no signal that Paxlovid might prevent long COVID … A third found that 11.8 percent of two million Medicare patients treated with Paxlovid developed symptoms suggestive of long COVID compared with 14.5 percent among those not treated.”
Do these slight differences mean anything? There is no real reliable definition of long COVID as of yet. Should we put people on this drug for a slight difference in one of three studies? The cost would be $8000 or so each. And there’s the side effect profile which I’ve discussed elsewhere. By the way, improvement with the drug was iffy. And any improvement often didn’t last long.
What I liked best about this article is that it could be written at all. That alone is a sign that the winds of change are blowing with gusto.
I think we all would be surprised at how many drugs we take have little to no benefit, or such a small benefit that the costs and the side-effects don’t justify their use. But someone is making bank.
Let’s tear the system down and start again.
In health,
DocofLastResort