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Ep. 154 Outpatient COVID-19 Therapy: Why the Controversy?

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Our guest is Peter McCullough, MD, MPH, consultant cardiologist and Vice Chief of Medicine at Baylor University Medical Center in Dallas, Texas. He is an internationally recognized authority on the role of chronic kidney disease as a cardiovascular risk state with more than a thousand publications and more than five hundred citations in the National Library of Medicine. His works have appeared in the New England Journal of Medicine, Journal of the American Medical Association, Lancet and other top-tier journals worldwide.

However, he is not with us to discuss the cardiorenal syndrome nor his many illustrious achievements in cardiology. Rather, he joins us to tell us about an article on the outpatient treatment of COVID-19 of which he is first author. The paper is titled and was published in the American Journal of Medicine online on August 6, 2020.

GUEST:

Peter McCullough, MD, MPH: Twitter

LINKS:

  • McCullough P, et al. “Pathophysiological Basis and Rational for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection” (Open Access in Am J. Med)

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5 Comments

  1. Anthony Perry, MD on 11/03/2020 at 3:33 AM

    What an interesting discussion.
    You touched only very lightly on the dark shadow over this whole subject, namely that it has sadly become political after the strong endorsement of HCQ by the President. And yes, it seems obvious to me that political viewpoints have effected the thinking and decision-making of academics and government agencies. And I think the HCQ issue may have leaked over into thinking about early out-patient treatment in general. It’s interesting that Dr. McCullough, a cardiologist, did not get into the discussion about the purported serious cardiac toxicity of short term HCQ, presumably because he thinks it is not a serious issue. Michel is right that the present scientific atmosphere is intimidating to the physician who has been inclined to offer such treatment.

    • Michel Accad on 11/03/2020 at 3:44 AM

      Thank you, Anthony. It wasn’t conscious but I’m glad we avoided bringing up the political angle.

    • Julia Bemer,MD on 11/15/2020 at 1:17 PM

      Dr. McCollough, thank you for publishing this guideline and giving me more confidence to go ahead and treat my patients. I too am of the opinion that it is unethical to wait for FDA licensing of these re-purposed generic medications in a pandemic situation. In Michigan, primary care physicians received a bulletin in the spring from the state licensing board discouraging the use of any non-FDA approved medications for Covid-19. The language was strong and there was no doubt the state would consider license review for those who elected to treat with HCQ. I also work for a large academic institution that has dismissed the involvement of outpatient physicians in the treatment of their own patients. I am fortunate that I have a mostly young adult patient population and have not had to take the risk yet – jeopardizing my job and medical license to treat my patients in good conscience.

  2. David Prebble on 11/03/2020 at 12:30 PM

    I am not a doctor but i am a concerned layman following this issue with careful attention and I wholeheartedly agree with Dr McCullough’s outpatient guidelines. I will declare my ‘conflicting interests’, as
    [1] age 50 is but a distant memory for me
    [2] having several significant co-morbidities

    The ‘Ivory Tower’ approach of ‘The Authorities’ requiring gold standard evidence cannot be morally or ethically justified. Desperate times call for ‘informed desperate’ measures. Every day we wait, a thousand die.
    The very fact that the CDC, NIH, and FDA have not given the American public even a ‘provisional’ medical protocol for prophylaxis and in particular, protocols for viral phase treatment, just beggars belief. All that is left for the physician is to treat the symptoms of Covid19 as best he can. The political entanglement of Governmental, Party loyalty, Big Pharma and Public health has resulted in a huge spaghetti like mess from which nothing useful seems to escapes to the world.

    By far the most effective target must be to treat early and aggressively at home and fend off the dangerous pulmonary phase of the disease thus avoiding many hospitalizations and the knock on harmful effects of bed and medical resource ‘blocking’ for all the other day-to-day medical illness and emergency.
    Once the disease gets past the viral stage the cat is out of the bag and that cat is a mean half starved tiger with serious attitude.
    Thus far, all of the ‘proven in the field’ treatments appear to me to be either OTC vitamins and supplements or cheap generic medicines often being used ‘off licence’ or ‘off target’ ie. repurposed. The safety of these drugs has been established over many years, though ongoing work is always needed to examine all possible drug interactions and contraindications and the like.
    Since there are no NEW drugs available that are proven to reduce mortality in the viral phase, the use of ‘proven in the field’ treatments, the elements of which are known to be safe, should surely be welcomed with open arms by Governments and Medical Authorities worldwide.
    To date, this has been, and must remain, an iterative approach based on trial, observation, reporting, review and change

    Though prophylaxis was not included in the discussion here, where there is ‘low hanging fruit’ in the form of supplements and vitamins this should be supported by health authorities, be made known to the public, and be effected by Primary Care Physicians. Even if supplementation cannot be shown to reduce the risk of infection, such regimes would put folks bodies in the best condition for reducing the risk of disease progression to a serious stage, should they become infected.

    The Corporate nature of America boded ill from the start of this pandemic.
    The fact that this is an election years has made things far worse but the biggest problem is surely, the total lack of national leadership. This virus demanded a coordinated response at Federal Level, not a mish-mash of different state regimes. Whether you are in red or blue states, the disease is the same, it does not care. To my mind, the failure to mandate mask wearing across the Nation is nothing short of lunacy. The disease is not going away anytime soon, indeed, we have yet to see the worst . The Government seem to have given up entirely. It is so sad that the very folks that should be leading the way, the Center for Disease Control [CDC] has in large part, become toothless and has had its advice censored or just plain ignored. The same is true to a degree for the FDA and NIH.
    Nowhere is this more true than in the Authorities’ handling of Hydroxychloroquine. I cannot help feeling that there is something rotten in the system and I hope that eventually this will come to light.
    Dr McCullough is absolutely right – History will not look kindly on the handling of this pandemic.

    America, with its huge medical and research resources is being shown the way to overcoming this disease by smaller, less well resourced and poorer Nations and we should bow down low in shame….. but we should be wise enough to follow !

    In today’s litigious society it takes a Physician of merit to ignore authority and do what is best for the Patient in front of him. These trail blazers cannot act alone and all such like minded Doctors do need to join together and generate fundamental change.

    Pray God there will be a major change soon.
    Stay safe

  3. Ricardo Estrada on 11/14/2020 at 4:34 AM

    Please send or post the next paper incluide Ivermectin data.

    To the autors, need to review Melatonin , Nitazoxanide and budesonide data

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