11/n There is no attempt to actually assess HCQ usage, despite this being SOMETHING YOU COULD DO You could look at HCQ doses given/purchases made in countries by date, for example Instead, the authors reference tweetspic.twitter.com/1QATjL1c0m
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22/n Whatever your opinion on HCQ - whether you are pro or for - you cannot conclude anything of value from this website It is misleading and wrong
23/n The discussion section is also, it must be said, a sight to behold They defend their decision to use the term "country-randomized controlled trial" despite CONTRADICTING THEMSELVES (countries deciding is by definition NOT RANDOM)pic.twitter.com/CVmzKGNCoc
24/n We already have a term for this kind of research - observational ecological study - so as I said, inventing a new term that is wrong is simply misleading. Just use the correct terminology if you're going to do something like this!
25/n If nothing else, the most basic additions that would make the website slightly less worthless would be - details of statistical analysis - measure of HCQ CONSUMPTION by country - deaths BY INFECTION as the outcome - control for other govt measures to prevent COVID-19
26/n Another point that's worth making - the authors say that HCQ is preventive of COVID-19 The methodology is not even vaguely close to what you'd need to know if that's true
27/n You'd want to see case numbers by day, along with every intervention (i.e. social distancing, school closures etc) and the day they were implemented for every country on the list Then, number of HCQ doses given by day AT AN ABSOLUTE MINIMUM
28/n Even if the authors make the suggested changes up until 25/n, they'd just end up with a meaningless correlation without measures like these, which are an enormous amount of work The thing about ecological studies is that the good ones take A LOT of time
29/n Oh, another thing The authors keep maintaining on Twitter that this study was "random" because patients didn't choose what treatment they got, countries did This is absolute nonsense
30/n Firstly, it is misdefining random If ANYONE chooses the treatment, then it's not random BY DEFINITION Random means no one chooses, it's that simple
31/n But also - PATIENTS DID CHOOSE This is where we get back to the ecological fallacy - it is absurd to suggest that individuals within countries didn't choose to take HCQ. Even countries that authorised it had adopters and non-adopters
32/n This protocol was BY NO POSSIBLE DEFINITION "random" Using the term is incorrect, and at best ignorant not just of the scientific terminology but also the colloquial meaning of the word
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