The Skeptical EP

The Blog Page of Robert Clare MD

“Questioning medical dogma to improve the lives of patients.”

Skepticism, from the Greek word skepticos (to inquire), is not simply a noun but a process. Skeptics demand evidence before accepting claims of truth; they enjoy the process of inquiry and analysis. Unlike cynics who take a negative view of both the claims of others and the people making them, skeptics are perfectly happy to change their minds when better evidence comes along. For physicians, a questioning attitude is an essential component to decision-making. When faced with increasing pressure from administrators and pharmaceutical companies to “Show me the money!” the best counter from the physician is “Show me the evidence!” The purpose of this blog is to raise awareness through an inquiry of the best available medical knowledge, to foster discussion, and to challenge prevailing truths in order to improve the lives of patients everywhere.

Disclaimer: The opinions put forth in this blog are just that: opinions. They should not be used as a substitute for your own good sense or that of your doctor. Readers of this column do so at their own risk—this blog is not intended to treat or diagnose disease. Information contained here should be considered a “dietary supplement.” None of it is FDA approved. Mistakes in data interpretation are mine alone (I don’t claim to be a statistician), and you should assume that mistakes will occasionally be made. All personal patient information has been altered.

I’m optimistic about … COVID-19 vaccines (part 2).

Vaccine Approval.

 The approval process for vaccines is arduous and involves the following steps:

  1. Preclinical: Laboratory and animal testing to determine potential use in humans.
  2. IND (Investigational New Drug) Application: Submission of R&D and preclinical data to the FDA for review and initiation of human trials.
  3. Phase 1: Generally, a small trial conducted in 20-100 healthy people to determine safety, dosage, and immune response.
  4. Phase 2: Mid-range trial conducted in several hundred people to assess dose-response and adverse events associated with the vaccine.
  5. Phase 3: Large RCT (Randomized Controlled Trial) involving thousands of people to assess efficacy (does the vaccine work under ideal conditions?) and safety (does the vaccine cause harm?) versus a placebo.
  6. BLA (Biologics Licensing Application): Comprehensive submission of all preclinical and clinical data to the FDA for review. There is no timeline for approval. In emergency situations like the COVID-19 pandemic, approval may be granted under an EUA (Emergency Use Authorization).
  7. Phase 4: Post-approval oversight and ongoing monitoring that may require post-marketing studies to further assess known or potential serious risks. Vaccines are closely monitored using multiple surveillance systems including: VAERS (Vaccine Adverse Event Reporting System), BEST (Biologics Effectiveness and Safety) program, the FDA Sentinel Program, the FDA and CMS (Centers for Medicare & Medicaid Services) partnership program, the V-Safe phone app, and the CDC Vaccine Safety Datalink.

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COVID-19 Update – Remdesivir.

The pharmaceutical landscape for COVID-19 treatments is rapidly changing. Since my post last week on hydroxychloroquine, three new reports have come out regarding the drug’s use: two related to cardiac side-effects, and a separate randomized controlled trial on the drug’s capacity to clear the virus and improve blood markers of infection and inflammation. Continue reading

I’m skeptical about … hydroxychloroquine.

March 21, 2020, Trump tweet: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains.”

The bully pulpit of the president still carries a lot of weight, and Trump’s repeated touting of the anti-malarial drug hydroxychloroquine for the treatment of COVID-19 provided incentive for FDA officials to approve its use under the Emergency Use Authorization section of the Federal Food, Drug, and Cosmetic Act one week after the above tweet. Continue reading

I’m skeptical about … CBD (cannabidiol).

     With passage of the Farm Bill in 2018, CBD (cannabidiol) products became legal in all states under federal law, provided they are derived from hemp containing less than 0.3% THC. But just as multiple states have legalized cannabis in opposition to federal laws that prohibit physicians from prescribing it, there are still several states where cannabis products including CBD remain illegal irrespective of federal laws to the contrary. Continue reading

I’m skeptical about … cannabis (part 2).

Most people harbor guilty pleasures. Mine have nothing to do with marijuana, but I do admit to a weakness for good spy thrillers, and it’s my interest in the latter that led me to write this post about the former. Alex Berenson, an ex-New York Times reporter, is the author of my favorite spy series about a CIA operative named John Wells. You can learn a lot about covert operations from reading this series, so when Berenson turned his attention to a non-fiction book warning about the dangers of cannabis called, Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence, it got my attention. Continue reading