Sorting Medical Fact from Fiction, Part II: We Need Therapy

About the time I began writing this, at the annual meeting of our New Mexico Society for Acupuncture and Asian Medicine, we heard a presentation from David Riley, MD about how to write case reports for publication in medical journals. That brought home to me how much goes into each published study that we read and how slow and incremental the scientific process can be.

At the same meeting, one of my senior colleagues went into a passionate rant about how the SARS-CoV-2 virus was engineered as a bioweapon and we are at war, hydroxychloroquine was great, we should all go to Fox News and Newsmax to get The Truth, and most stunning of all, that President Trump was the highest order of doctor because he saved the lives of the people of America by instituting a travel ban.

The rest of us sat there and gazed bemusedly at our Zoom screens. It was deeply disturbing to find one of us, a highly educated and intelligent man of mature years, spouting poisonous bilge like that. In fact, it was almost physically painful.

Then, just a few days later, we got the news that the conspiracizer-in-chief himself had come down with COVID-19. Immediately more conspiracy theories began to fly from both left and right. He was given treatments that sounded reasonable, including an experimental antibody preparation. (I don’t know why they were not adding vitamin C to the vitamin D and zinc.) That is, the treatments sounded reasonable, if we can actually believe what we were being told about them— and we are in the habit of not believing much of anything anymore. The Old Man Who Cried Wolf has trained us that way.

Dexamethasone, a common steroid that is often given in severe cases of COVID, was part of the president’s regimen. Since getting out of the hospital, he’s been even more impulsive, erratic, and incomprehensible, and many observers are assuming he’s still dexamethazoned.

Conspicuously, he was NOT treated with his famously favored hydroxychloroquine. Isn’t that interesting.

I originally started writing this post because there are people I respect, people who are influential writers and teachers, who are still touting hydroxychloroquine and insisting that it is being kept from patients by nefarious forces, just like my colleague. They still believe the persistent myth that HCQ, either by itself or with azithromycin, is a terrific treatment for COVID-19 and can be used for prevention too, but is being suppressed by Big Pharma, the FDA, The Government, etc. in order to market more expensive drugs and/or force everyone to accept a vaccine, take your pick.

Let’s try applying some logic to this. (I know, I know, nobody does that anymore.)

In order for this contention to be valid, first, there would have to BE an expensive and effective drug to market instead, either one already in existence or one being developed. As far as I know there is no such thing. Remdesivir might be what they have in mind, as it has shown itself to be useful and costs over $3000 per course, but it isn’t a “cure” and it doesn’t help with prevention. In fact, it’s still unclear whether it really helps much at all.

“J. Randall Curtis gives remdesivir to his seriously ill coronavirus patients based on statistics, not his own experience. From the bedside, he said, benefits of the drug are undetectable.
“It’s hard when you’re on the front line, knowing whether it makes a difference. People are not jumping out of bed and saying, ‘Thanks, you saved my life,’ ” said Curtis, a doctor at Seattle’s Harborview Medical Center. “We are continuing to use it, because if you look at all the data in total, there probably is some benefit.”

Second, some very inexpensive drugs and substances have come to the forefront. They are still not “cures,” but they are helping quite a lot. Dexamethasone is one. It only helps in advanced cases where a person needs help to breathe, but in those cases dexamethasone and other well-known steroids can damp down the inflammatory reactions that kill people. These are familiar medications, basic medical workhorses with wide applications, being repurposed for the present situation. There’s no new drama to be found in this story— steroids are being used to combat inflammation just like always— and there are no prominent politicians hyping it at rallies, so no one seems to be making up myths about it. Yet it’s one of the more important discoveries that’s been made about treating COVID-19.

A few months ago there was excitement about another cheap and widely available drug, famotidine (Pepcid), because people who had been taking it for heartburn and then got COVID did better than COVID patients who had not been taking it. As far as I know there is still research going on with famotidine, but I couldn’t find any very recent references to studies about it. I did hear that it was given to the president— but he hasn’t even mentioned it.

https://www.healio.com/news/gastroenterology/20200817/famotidine-linked-to-improved-outcomes-in-covid19

https://www.sciencenews.org/article/coronavirus-covid-19-heartburn-medicine-pepcid-does-not-work-antiviral

The concept is that famotidine and other histamine blockers may be able to block the cytokine storms (catastrophically overwhelming immune system reactions) that contribute to deaths from COVID. An intriguing study combined famotidine with the antihistamine cetirizine (Zyrtec):
https://www.sciencedirect.com/science/article/pii/S1094553920301462

Anticoagulants, including the old standby heparin, are important in countering the widespread clotting that often occurs with COVID-19 and can cause strokes and heart attacks. Here is one of many reports about that:
https://www.acc.org/latest-in-cardiology/articles/2020/08/26/12/45/anticoagulants-associated-with-better-survival-lower-risk-of-intubation-in-covid-19-patients

Azithromycin, very often given for sinus infections as a “Z-Pack,” was famously given along with HCQ, and is being studied in other contexts. Since antibiotics in general don’t kill viruses, why is this happening? It seems that azithromycin may actually have a role in fighting certain viral infections.
“Azithromycin is known to have immunomodulating and antiviral properties. In vitro studies have demonstrated the capacity of azithromycin in reducing production of pro-inflammatory cytokines such as IL-8, IL-6, TNF alpha, reduce oxidative stress, and modulate T-helper functions. At the same time there are multiple clinical evidences of the role of azithromycin in acute respiratory distress syndrome and against Middle East Respiratory syndrome (MERS).”

https://www.sciencedirect.com/science/article/pii/S0924857920302235

(Unfortunately, this article adds, “Furthermore, there are some concerns regarding the association of azithromycin and hydroxychloroquine because of potential QT prolongation. In fact, both drugs have this as a potential side effect and evidence regarding the safe use of this combination is controversial.”)

Are any of these drugs being “suppressed”? No. Are right-wing politicians yelling about them? Not that I know of. Maybe they should be, as the public would probably like to know more about them. But they’ve already invented their conspiracy theory, and I guess they don’t need another one.

Not that hydroxychloroquine is useless by any means. I have patients with autoimmune conditions who depend on it. But I also know of someone who died when his employer required him to take it as supposed prevention for COVID. The fact that it isn’t being widely used to combat this pandemic is NOT, I repeat NOT, a sign of a conspiracy to suppress it. It just hasn’t panned out as hoped. Nothing I have found from any credible source has said that it helped a majority of COVID patients. Some, it appeared to make worse. 

You don’t have to take my word for it. Even the most cursory search brings up multiple studies and articles.
https://www.statnews.com/2020/07/16/new-covid-19-study-despite-flaws-adds-to-case-against-hydroxychloroquine/

https://www.washingtonpost.com/business/2020/04/21/anti-malarial-drug-trump-touted-is-linked-higher-rates-death-va-coronavirus-patients-study-says/

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

https://bgr.com/2020/05/22/coronavirus-drug-hydroxychloroquine-harmfull-side-effects-death-covid-19/

I note that one study that appeared to show benefit from HCQ used it in conjunction with steroids, which may have been the part that actually worked.
https://www.msn.com/en-us/health/health-news/study-finds-hydroxychloroquine-helped-coronavirus-patients-survive-better/ar-BB16hifu

There are still sources I consider very respectable who are recommending hydrochloroquine, such as the following. As far as I can tell, such sources are quoting studies from a number of months ago, which is a lifetime in terms of COVID-19 research. More recent studies are not looking favorable, and those are the ones I’m paying the most attention to.
https://chriswoollamshealthwatch.com/your-illness/general-health/potential-covid-19-treatment-chloroquine/

Has HCQ helped anybody recover from COVID-19? Possibly. People are all biochemically different from each other. A given person might respond to a given treatment that didn’t work for most others. In the search for treatments that help the broadest population of patients, though, HCQ has appeared to be a dead end.

You have to realize that health care professionals, especially those who work in hospitals, have every reason to want effective medications for COVID. They are the ones most directly in the line of fire. If something is seen to work, even the least altruistic doctor one can imagine is going to want to have it available. If hydroxychloroquine, or HCQ plus azithromycin and/or zinc, really knocked down COVID-19 infections, and did it safely, I can’t think of any downside to distributing it everywhere. Who could possibly object? We’d all be a lot closer to resuming our regularly-scheduled lives by now.

It’s reprehensible that this has become a matter of politics. We can’t afford for it to be political.

My impression is that people often think medical authorities or pharma companies have far more information at hand than they really do, and that they must be hiding it from the rest of us. The reality is that we are all figuring this pandemic out as we go along. By the time you read this, there may have been some truly game-changing discovery— one can hope. More likely, we’ll just keep incrementally adding to our understanding. Science is a slow process, one that’s supposed to be careful and rigorous. No one is supposed to make claims before they have solid evidence, and evidence takes time to accumulate. I’ve spent many hours in virtual meetings and webinars with local infectious disease experts and public health workers, and what I see is a bunch of sincere, intelligent people doing their best to make sense of a situation that no one completely understands yet.

There has also been a persistent charge that the authorities must be dishonest because they have changed their recommendations at times. Science, as well as plain common sense, changes our understanding as new information comes in. Holding to the same opinions no matter what facts come along is more like religious belief, and that sort of bullheaded unwillingness to think has no place in a public health crisis, where we must all be willing to adapt to constantly changing knowledge and circumstances.

 

ICAM, vitamin C, and other supplements

What about vitamin C? To the best of my knowledge and googling skills, research on the use of IV vitamin C in hospitalized COVID-19 patients is ongoing and we don’t yet have study results. This summary comes from the Linus Pauling Institute:
https://lpi.oregonstate.edu/COVID19/IV-VitaminC-virus

My colleague Daniel Cobb, DOM wrote this extremely intriguing article which postulates that advanced cases of COVID-19 result in a form of scurvy. The idea is that fighting the virus uses up so much of the body’s store of vitamin C that collagen fibers can’t be replaced, leading to breakdown of tissues in the lungs and blood vessels, with fluid in the lungs and bleeding plus clotting in the vascular system. This can help explain why a patient may appear to be recovering, then suddenly crash.
https://www.faim.org/covid-19-is-really-two-diseases-to-treat-the-second-one-you-have-to-name-it-correctly

If I were hospitalized with COVID-19 or any severe pneumonia or similar illness, I would want to be given IV vitamin C. The evidence looks strong enough to me, and harm looks relatively unlikely.

Vitamin C is a major part of a strategy developed in Florida called ICAM.
https://bgr.com/2020/09/26/coronavirus-cure-icam-protocol-florida/
“ICAM isn’t a new drug, it’s an acronym for a combination of existing medications used simultaneously on patients. It uses Immunosupport drugs (Vitamin C and Zinc), Corticosteroids against inflammation, Anticoagulants against blood clots, and Macrolides to help fight infection.”
“…Norwood-Williams continued, ‘What we found out was that ICAM works as a strategy for super defense for the body. It doesn’t kill coronavirus, but it doesn’t need to. Viruses are self-limiting anyway. They have a very short life cycle. What kills people are the consequences of coronavirus in multiple ways.’”

(Macrolides are a class of antibiotics that includes azithromycin.)

A role has also been suggested for B vitamins in preventing deadly cytokine storms.
https://www.maturitas.org/article/S0378-5122(20)30348-0/fulltext#%20

Of course vitamin D is also important in any problem involving the immune system. It has been shown that low vitamin D levels make people more vulnerable to infection. What hasn’t been shown as yet is that giving vitamin D to a person who is already ill makes a difference. The most important thing we know regarding vitamins is that it’s best to keep your internal shelves well stocked with them at all times.

What should you take away from all that? If you were my patient, I would definitely recommend continuing supplements of C and D as well as a good-quality multivitamin. In general, keep your nutritional status as high as you can, eating a variety of colorful fruits and vegetables, olive oil, nuts, and fish, as tolerated. I would say that under any circumstances, but it’s truer than ever now.

The Linus Pauling Institute has a good summary of general nutrition for immunity too:
https://lpi.oregonstate.edu/COVID19/nutritional-strategies-immune-system

 

Chinese herbs, in China and in the US

It would be easy for us practitioners of herbal medicine to fall into paranoia when thinking about the lack of use of antiviral and other herbs for COVID-19 in the US. Have Chinese herbs been suppressed as a treatment? Well, sort of, because of the way our US regulatory system works. I just don’t think it’s a Nefarious Plot.

Chinese doctors already had experience developing herb formulas to treat SARS in the early 2000s, as well as for epidemics over the centuries. When COVID hit, they had a place to start. They quickly put together herbal strategies that could treat the range of symptoms they were seeing, and the published literature on those looks quite positive. They also ramped up the use of venerable formulas for prevention.

John and Tina Chen at Evergreen Herbs/Lotus Institute have done a great service by translating materials from China about specific herbs and formulas that have been used against COVID. A lot of this is layperson-friendly, and all of it is free to access.
https://www.elotus.org/articles

Herbal pharmacology is a well-established science, and many herbs have been shown to inhibit the reproduction of viruses, prevent them from entering cells, break up thick phlegm, act as anticoagulants, or do other things that are relevant to this disease. John Chen has given webinars that explicated specific mechanisms by which components of herbs can accomplish their actions against coronaviruses, some of which are the same as those of antiviral drugs. It’s fascinating.

I’ve stocked up my clinic’s pharmacy with all the herbs I can get from the Chinese protocols. Since I have not needed to treat any patients with current cases of COVID, thankfully, I haven’t used the formulas for the acute disease, but if I or my family members get sick, we can start treating immediately, and if patients do report symptoms, I can deliver herbs to them. We have been making use of time-honored preventive formulas over the months.

However, in this country, we are not even allowed to say that we can treat COVID with any means outside mainstream medicine. (Note that I am telling you only that certain protocols have been shown to help in China and that certain herbs have been shown objectively to have relevant actions, not claiming that any specific herbs treat or cure the disease.) Colleagues across the country have used herbs successfully against this virus nonetheless. I have yapped as loud as I could about this to any medical person who would listen.

There hasn’t been a big result. Does this mean that They are trying to suppress the use of herbs? Not necessarily. In the US, herbs are regulated more like food and less like drugs; another regulatory category for traditional medicine is clearly needed but has not been created as yet (long story, won’t go into it here). That means that making claims that an herbal product treats a disease is fraught with difficulties.

In China, herbs are prescribed in hospitals, often cooked as water decoctions in the traditional manner. Here there is no way to accomplish that in a hospital. If doctors in American hospitals wanted to give already-prepared herb formulas in pills, I suppose they could, but then there would be no insurance reimbursement, nor pharmacists who knew what to do with those medications. Our system just isn’t set up to use natural substances in hospital settings, or to make them affordable to patients who can’t pay out of pocket. My impression from trying to get the information from China in front of MDs is that they are often very much open to it, but they’re not sure how to make use of it. In practical terms, that means it all falls by the wayside.

In addition, there is some prejudice here about studies done in other countries, very much including China. American regulators and doctors typically want to see evidence from studies done here, or at least done exactly the way they would be done here, whether that makes sense in a given case or not.

I have the most intense hope that medicinal herbs will be employed far more than they have been so far, and that we can tap into the wealth of Asian medical experience to improve our own situation. On a small scale, I’m sure we can. Unfortunately, the same kinds of holes in our healthcare “system” that plague us on other levels make it unlikely that this will happen in a widespread way anytime soon.

Despite all that, we should be making more use of herbs, and I would like to see forces within my own profession advocating more strongly for them. We don’t have a lot of options. MDs complain that we don’t have enough tools in our toolbox, but most of them don’t even know about these important tools that we’ve had for many years.

 

One definite upside to this year of medical horror is that we are being forced to learn so much, knowledge that will help us to cope not only with this pandemic but with the next one and the next.

5 Comments

Filed under health and healing, politics, psychology

5 responses to “Sorting Medical Fact from Fiction, Part II: We Need Therapy

  1. Mendy Lou Blackburn

    Very informative! Thanks for putting in the effort Elene.

    >

    Like

  2. Thank you very much for this article, Elene, and your balance and perspective, particularly about the medical profession trying to tackle unknown ground.

    Like

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