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Saturday, June 18, 2016

It's Achille's, Stupid!

It's Achille's, Stupid!
This paper was originally published here, in French. We provide this translation for your convenience. Some practical aspects may differ where you live.

I found this rather funny:

I love this shortcut: my doctor preferred not to play the sorcerer's apprentice: he added Edurant® .... Contemplating the result: Bravo! What did I not hear about the risk of alleviated treatments. As if adding more (or maintaining too high, it's the same ....) was safer !!! Physicians should take decisions together with patients, after explaining risks. But in practice, does the patient (or doctor) really understands what is at stake?

It is Achilles, stupid!

There are only 2 possibilities: either the risk is random, indiscriminate, or it is unevenly distributed, highest in one group, and therefore, lower or nihil in another.

It is in the best interest of Big Pharma and its relays to make believe that the risk is high and indiscriminate. This does not resist the accounting of known, documented and registered cases.

This is why we can not find anywhere this comprehensive, yet simple, accounting. It is described here: The Achilles heel.

If the risk is random: four failures out of 61 (33 + 28 Barcelona + Paris): 6.5%: it is not high ...

If it is not-random, it is based on risk categories: here, everyone speculates (without any evidence) one says the 'reservoir', this other the 'CD4 count', this one the 'Nadir', that one 'the dose'. Dr. Jacques Leibowitch proves that this is all bullshit. What about C. Katlama's presentation, which provides us very kindly, these parameters, including the historical presence of Achilles' heel? Let's fill the confusion tables, and see which one is the most relevant.

Let's build the confusion table ...

Everyone expresses an opinion on the conditions required before attempting dosage reduction. Most times, this is not consistent with the evidence from clinical trials. For example: make of a good immune reconstitution a necessary requirement: then one comes up with a threshold of CD4 = 350, another 500, another says 800, and why not 2000 while you are at it?

Let fill the confusion table for the criteria 'good restoration' with a threshold of 624 CD4 count (for that is the median, published by C. Katlama EACS-2015, in her trial patient pool).

Is a criterion of good immune reconstitution, before switching to maintenance monotherapy with Tivicay®, effective? NO!

Proponents of this (false) criterion would have excluded half of patients (14), barred, unduly, 13 patients fromt from this strategy beneficial to the patient; They would not have prevented 2 of the 3 failures!

To have a 'criterion' sensitive enough, they should have set the bar at CD4 = 1200; ie virtually exclude everyone! Exclude everyone from a strategy that works for more than 93%: what are they thinking ?!

Well... Who knows of our Parisian virologists will not be surprised.

Fortunately, Pr. C. Katlama saves our face despite this incompetent clique:

The criterion 'Achilles heel' has a sensitivity of 100%.

The criterion 'Achilles heel' has a 100% sensitivity (accounting source C. Katlama EACS-2015)

There is room for improvment, since specificity is only 60%. If we follow blindly this criterion, we unnecessarily exclude 10 of 13 patients, i.e. 75-80%.

Nevertheless, when we put side by side the tables for the (bad) 'criterion' reconstitution and the (good) criterion 'Achilles heel': there is no much room for discussion!

Paraphrasing the famous 'it's the economy, stupid !', and despite being a modestly specific criterion: it is the Achilles heel, stupid !

As for bystanders, leave them to their useless speculations, which are as many superstitions.

Science is the poetry of reality. (Richard Dawkins)

Upcoming posts: How to get a script for 1 year, why avoid the TruLight trial, how to wean antidepressants, dose-reducing doctors ...

Do not hesitate to leave your comments and questions...

Good Weekend and good fuck!

This paper was originally published here, in French. We provide this translation for your convenience. Some practical aspects may differ where you live.

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