I took an oath, dammit. 20 years ago. I meant it then, I mean it now. I have sacrificed my time, my youth, my family, friends and paid dearly for that oath. I studied, succeeded and sometimes flopped, but always, had the patient in my foreground. Today is a day where I have seen a country split hopelessly in half. The frontline of medicine now as broken as everything else in our country. We stand around bickering about an ancient, non lethal medication and trying to ruin each other's careers while the diseased collapse in our rear view.
Do no harm, dammit.
I have watched medications swing in and out of fashion like flare bottom jeans and scrunchies. When I started residency, we would put patients on Mag Sulfate drips for a week for preterm labor, give Phenobarbitol for brain protection of the preterm during delivery. We would put Zofran subcuticular PUMPS in pregnant women for nausea for Pete's sake! Mag went out of fashion, but now is back once again, but not more than 2 days... and round and round we go...
The wonderful thing about the practice of medicine is that you have the ability to actually practice medicine. It should be a relationship, not a formula.
We are now in the dizzying world of COVID, a disease we've never had to deal with until a few months ago. Like any clinician, I started reading early about what they were doing overseas to treat this, and read of a few protocols that used HCQ, or Plaquenil. I found it interesting because, I take it regularly and have for several years. Started researching in my Harrisons (authored by Fauci), and noted that HCQ has some weak anti viral activity. In the early days of US COVID, it looked like a promising combination, at least for outpatients. Unfortunately, we got overwhelmed on the coasts with older, sicker inpatients too quickly, and that outpatient cocktail was ineffective. It's now percolated to the inner part of the USA, and the patients contracting it are younger, healthier and able to be managed outpatient, and thus the HCQ, Azithromycin, Zinc combo keeps poking it's head up. (also in various combinations with Vitamin C and D, Quercetin, Melatonin, Famtodine, and a Symbicort inhaler)
Here's what I don't understand, it wasn't until after the President touted it's use that it became illegal to use in some states. Did you read that? ILLEGAL. A 60 year old, generally safe, well studied medication, used all over the world for decades - suddenly physicians were being punished by governors and their state medical boards for giving treatment that they decided was in the patient's best interest. What world am I living in?
Do no harm.
We give medications ALL DAY LONG that are not FDA approved for the induction of labor. We give Makenna for preterm labor, even though they say now it's not recommended. WHY? Because it won't hurt anything and it might just help. Why is it that when you go to the hospital and pee and they find 2 bacteria in your urine you leave with an antibiotic? Because it won't hurt anything and it might just help. Why is it that you get diagnosed with COVID and go home and get told to take some zinc and Tylenol, and if you're lucky you get a Symbicort inhaler? I have no freaking idea. Take the Vitamin C, D, and Zinc, + the Azithromycin and HCQ. It won't hurt, and it might just help. By saying something so grossly obvious its almost painful, I will be looked at as unscientific, fringy, and some would be malignant enough to try and strip my medical license. If you don't agree with it, don't prescribe it. If it is prescribed to you and you have concerns, DON'T TAKE IT. It really doesn't have to be any more complicated than this.
People take that approach with hormones all the time. Some are pro hormones, some are deathly afraid of them causing cancer, some doctors give compounded ones, some use only FDA approved ones, none of us are trying to attack each other. There's room for everyone in medicine. At least there was. Look, the doctor that gave the HCQ speech was passionate, not terribly prolific and the delivery could have been much better, but I think her heart was in the right place. She just wants to see COVID patients recover. We all do. Why obstruct the use of HCQ? Just let people use it, and document the heck out of it and lets find out if it works! It just might! Or, it might not! Arguing about it isn't getting anyone better, and its killing the doctor's souls. We need each other, so we've got to stop eating our own. COVID doesn't have to kill us all, but if we don't stop this nonsense, it really might.
Do no harm.
