Jacob Puliyel Gresham’s Law and the Covid-19 pandemic
By Jacob Puliyel
Published June 29, 2020, 11:04 am Sunday Guardian Live
Gresham’s law holds that bad money drives out good money. If there are two coins with the same face value, but of different intrinsic value (assume that one is made of a more precious metal) the coin with less intrinsic worth (bad coin) will be used for currency transactions and the more valuable coin will go out of circulation.
This law applies to the pharmaceuticals today. If there are two drugs of comparable efficacy, the drug that costs more (bad coin) will drive out the good drug (less expensive one) out of the market. It is unfortunate that we are experiencing this in the midst of the humanitarian tragedy of the Covid pandemic.
The present pandemic is caused by a novel virus and mankind has no experience with how to deal with it. There are no drugs or vaccines we know will work. To fight the virus, one approach is to re-purpose approved drugs developed for other uses. A variety of drugs in the market can be tested for efficacy against the new virus. We will discuss the testing of two such drugs against Covid-19.
Remdesivir is a candidate drug. It had been developed for the Ebola virus but it was not found to be effective against it. A generic version of the drug manufactured by Hetero costs Rs 5000 to Rs 6000 per vial. The 11 vials needed for a 10-day course costs Rs 55,000. Remdesivir was subjected to a clinical trial against Covid-19 and the early results of this study were published by Beigel and colleagues in the New England Journal of Medicine (NEJM) on 22 May 2020. There was no statistically meaningful benefit for survival with use of the drug, but among those that survived, recovery time was reduced by four days to a median of 11 days instead of 15 days. The US FDA has approved this drug for compassionate use.
Hydroxychloroqunin (HCQ) is another drug under consideration. It is an antimalarial drug that costs Rs 68 for 10 tablets and a course of treatment requires 12 tablets. The WHO studied this drug in 400 hospitals in 35 countries. It was called the Solidarity trial. However, on 22 May 2020, on the same day that the Remdesivir report appeared in the NEJM, another famous medical journal, The Lancet, published a report that HCQ caused 35% more deaths due to adverse effects of the drug in another trial. Within three days of the publication of the Lancetpaper, the WHO suspended the Solidarity study.
India, however, decided to defy the WHO and continue its trial of HCQ. During the period when the Solidarity study was suspended, the Indian Council of Medical Research (ICMR) wrote to the WHO, that Solidarity schedule was employing four times the recommended dose of HCQ. The WHO schedule prescribed 1600 mg of the drug on the first day and total of 9600 mg for the full course of treatment. This dose was likely to be toxic and potentially fatal. Dr Vinod Paul in the Niti Aayog was of the opinion (New Indian Express 29 May) that the drug given in the correct dose was useful against Covid in India.
It turned out that the Lancet paper about HCQ deaths was fraudulent and used fabricated data. The Lancet paper was retracted within 13 days of publication. On 3 June, the WHO resumed the Solidarity HCQ study. Inspite of the warning about the drug dosage from the ICMR, the same toxic dose was continued.
Ten days later, Dr Meryl Nass, an US physician and expert on adverse reactions with drugs, wrote in her blog on 14 June 2020 about the lethal dose of HCQ being used in the Solidarity trial. People on Twitter, took it up. Three days later, on the 17 June, the WHO announced that it was suspending the HCQ trial because ‘there was no reduction in mortality’ with the drug, without any mention of the controversy about the drug dosage being used. No data was published.
By a strange coincidence, on the same day the WHO stopped its HCQ trial, the UK announced that it was stopping its trial of HCQ (called the Recovery trial) because they found simultaneously, that there was no reduction in mortality with the drug. The UK Recovery trial was funded in part by the Bill & Melinda Gates Foundation (B&MGF) and it was also using the same toxic dosage as the Solidarity trial. No data was provided about the other outcome measures like the reduction in time to recovery.
One can see the contrast here between the trials with the two drugs. The Remdesivir trial reported in the NEJM had found no reduction in mortality but the trial was continued on the basis of an improvement in recovery time among survivors. This was not reported on in the HCQ study. Clearly there are different standards operating here for the two drugs.
We cannot let matters rest here. The Lancet paper was retracted but we need to investigate who was really behind this effort to fraudulently discredit HCQ. “Surgisphere” is reported as the organisation that manufactured the data, but who got them to do this? Did they get any extraordinary help from the journal for publication?
Was this a concerted effort by pharma to discredit the less expensive drug? While it is made to appear as a rogue company “Surgisphere” appears to have done this to improve its visibility, it is necessary to have a deeper investigation into the motives and involvement of others, including publishers.
Further, one needs to know who was responsible for putting lives at risk by recommending toxic doses of HCQ in Solidarity and Recovery trials. One cannot assume this was an unintentional mistake, as the dose was not corrected even after the error was pointed out by the ICMR. We need to get to the bottom of this and those involved need to be discredited and weeded out, if we do not want bad science, like bad coins, taking over the world. If this is not done, in all probability, the results of the ICMR HCQ study will not be allowed to be published. Grisham’s Law of Pharmacotheraputics–only expensive drugs will show positive results.
"We need to get to the bottom of this and those involved need to be discredited and weeded out...."
"Discredited"? They need to be criminally prosecuted for homicide!
Seth Farber, Ph.D
Posted by: Seth Farber | July 02, 2020 at 07:56 AM
Michael,
Thank you for the link...great and important read.
Posted by: Laura Hayes | July 02, 2020 at 06:41 AM
I remember reading more than a decade ago about the sad state of peer review and it means very little.
I found this which says a lot:
"In 1986, appalled by the sad state of the scientific literature, I wrote that whether in spite of, or because of, the peer review system: “There seems to be no study too fragmented, no hypothesis too trivial, no literature citation too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print” (Rennie 1986)."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875766/
Posted by: michael | July 01, 2020 at 07:58 PM
400 hospitals and 39 countries -- equate to how many people being over dosed on purpose with hydroxychloroquine?
I can't wrap my head around the fact that they would willingly endanger and kill people.
Can big people doing research like this, get away with murder?
Posted by: Benedetta | July 01, 2020 at 04:58 PM
Thank you Jacob. I will add Gresham’s law to my collection of corrupt corporate and establishment practices.
In the UK our Health Secretary Matt Hancock was seduced into ordering stocks of Remdesiver, enough to treat our rapidly dwindling Covid-19 hospital cases, before President Trump bought up the entire world supply.
https://news.sky.com/story/coronavirus-us-buys-up-almost-entire-world-supply-of-covid-19-drug-remdesivir-12018430
http://www.pulsetoday.co.uk/clinical/clinical-specialties/infectious-diseases/antiviral-drug-remdesivir-approved-for-covid-19-treatment-in-the-uk/20040868.article
"Antiviral drug Remdesivir approved for Covid-19 treatment in the UK"
No matter - Trials in the UK of alternative Covid-19 treatments and therapies, have found a much more effective and cheaper alternative:-
Coronavirus: Dexamethasone proves first life-saving drug
https://www.bbc.co.uk/news/health-53061281
By Michelle RobertsHealth editor, BBC News online
16 June 2020
QUOTE:_
"A cheap and widely available drug can help save the lives of patients seriously ill with coronavirus.
The low-dose steroid treatment dexamethasone is a major breakthrough in the fight against the deadly virus, UK experts say.
The drug is part of the world's biggest trial testing existing treatments to see if they also work for coronavirus.
It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth.
Had the drug had been used to treat patients in the UK from the start of the pandemic, up to 5,000 lives could have been saved, researchers say."
Posted by: Jenny Allan | July 01, 2020 at 11:19 AM
The smoke screen put up is as below not willing to share hard data....no mention of wrong dosing..
Covid-19 studies based on flawed Surgisphere data force medical journals to review processes
New England Journal of Medicine and Lancet peer reviewers did not see raw data behind findings before publication
https://www.theguardian.com/world/2020/jun/12/covid-19-studies-based-on-flawed-surgisphere-data-force-medical-journals-to-review-processes
Some analysts are stupid enough to print just about anything and the Lancet is worse because it does what its told these days.
Disgusting how they model Wakefield into it to cover the pharma crimes..
"It was the Lancet that under the same editor, Richard Horton, published a fraudulent study linking the measles, mumps and rubella vaccine with autism. In 2010, 12 years after the paper was first published, the Lancet retracted the paper. The author of the paper, Dr Andrew Wakefield, was also banned from practising medicine in the UK due to his fraudulent work."
Pharma For Prison
MMR RIP
Posted by: Angus Files | July 01, 2020 at 11:13 AM
Trump defunded WHO Hooray!
The State Department won't let trump defund WHO.
And WHO gets to continue with our money! GRRRRRR.
Posted by: Benedetta | July 01, 2020 at 10:43 AM
Public Health officials are reluctant to acknowledge the anti-virus defense mechanism mediated by the alternative cellular energy (ACE) pathway. To do so would uncover research on stealth adapted viruses, including their role in autism. An extensive review of the ACE pathway is online at https://pubmed.ncbi.nlm.nih.gov/32066365/ Enhancing the ACE pathway can explain the successful results obtained with hydroxychloroquine. There are more effective approaches to enhancing the ACE pathway then using hydroxychloroquine.
Posted by: W John Martin MD, PhD | July 01, 2020 at 10:34 AM
Jacob warns:
"The Lancet paper was retracted but we need to investigate who was really behind this effort to fraudulently discredit HCQ. “Surgisphere” is reported as the organisation that manufactured the data, but who got them to do this? Did they get any extraordinary help from the journal for publication?"
Indeed .. WE NEED TO INVESTIGAT WHO WAS REALLY BEHIND THIS EFFORT TO FRAUDUENTLY DISCREDIT HCQ … WE NEED TO KNOW WHO GOT "SURGISPHERE" TO DO THIS.
Then .. AFTER INVESTIGATION OF WHO DID WHAT FOR WHOM … WE NEED TO PROSECUTE ALL INVOLVED UNDER PROVISIONS OF THE RACKETEER INFLUENCED AND CORRUPT ORGANIZATIONS (RICO) ACT AS OUTLINE BELOW:
"The Racketeer Influenced and Corrupt Organizations (RICO) Act is a United States federal law that provides for extended criminal penalties and a civil cause of action for acts performed as part of an ongoing criminal organization. The RICO Act focuses specifically on racketeering and allows the leaders of a syndicate to be tried for the crimes they ordered others to do or assisted them in doing, closing a perceived loophole that allowed a person who instructed someone else to, for example, murder, to be exempt from the trial because they did not actually commit the crime personally."
This is a perfect opportunity to hold "LEADERS" of a "criminal organization syndicate" RESPONSIBLE FOR THEIR CRIMES .. of course it would require determined Attorney Generals of all 50 States to prosecute the POWERFUL LEADERS FOR THE CRIMES THEY ORDERED OTHERS TO DO OR ASSISTED THEM IN DOING SO.
Somehow I just can't see even ONE such determined Attorney Genera holding this CRIMINAL SYNDICATE RESPONSIBLE.
Posted by: Bob Moffit | July 01, 2020 at 07:19 AM
Thank you , very good article,
Covid-19 Rapid Guideline: NICE. National Institue Clinical Excellence.
Managing symptoms ,including at the end of life ] in the community
Last updated 30 April 2020
The Trade- off between the benefits and harms of an intervention .
Read them and weep at the state of the damn Guidelines !
Jings ,I had to support two sprite-active-elderly women between the supermarket space and the car park yesterday afternoon . Both wearing masks while out and about shopping.
One took a nose dive forwards into the geranium bedding plants in front of me , the other went tilt sideways beside the reduced price apple trees !
Damn masks Guidelines -people not getting enough oxygen intake ?
Teachers looking at lessons outside of school buildings with no masks required ?
Not much sunshine but pleanty of fresh air !
Druids Chant- Scotch and wry- YouTube
Teachers will wear white uniforms ,students will wear same outfit, but psychodelic material for identification purposes !
Supporting the sprite-active-elderly ones !
Smelling Salts in handbag for next supermarket trip!
Ma great uncle Murdo MacDonald Assistant Chief Constable for Hamilton was talking about this problem in the 1920s/30s "The Frankfurt School" Opposite side of the same coin as Hitler!
"And the best china teacups were left dancing on their saucers!"
Posted by: Morag | July 01, 2020 at 06:50 AM