115

This was originally published here, in French (link).
We provide this translation for your convenience. Practical aspects may differ where you live.



Omnibus at the Salpatrière!

By Charles-Edouard!

It's going well for our friend Joëlle:

First of all, we're happy for you, and as far as medical follow-up goes, look what happens:

Charles-Edouard! and OMNIBUS at the Salpêtrière

The excellent seminar at Pasteur gave us a boost. As ANRS-4D has a 100% success rate in compliant patients, what can Quatuor bring if not a confirmation? At worst, there will be some failures, but so what? We will be able to better circumscribe the eligibility... The procedure is 100% risk-free. We already know that it is 100% without damage or after-effects: a simple return to 7/7, with the same combo, is sufficient, without prejudice.

Quatuor has a mandatory checkpoint, in a few weeks. They are going to publish an intermediate assessment to authorize (or not) the candidates who have been willing to stay in the delayed arm (7/7) to switch to 4/7. We will then know how many patients, in the 7/7 arm, have sent the ANRS packing by switching, on their own, to 4/7, since it is... authorized by Morlat!

The whole of Paris that counts expects excellent results. In particular, the Salpêtrière, which has provided the largest contingent, and therefore has a good idea (patients and practitioners know which arm they are in). Quartet or not, we have the wind in our sails, and it's not to go in circles!

Leibowitch considers himself out of the game because of his age, and wants to pass the baby on. In order to give credence to this retreat(do you really believe it?), he has effectively worked to open up a presentation opportunity for us at the Salpêtrière. The echo of our success at Pasteur comes back to sensitive ears.

So here we are, invited by Pr. Eric CAUMES, to a presentation, a staff, on Thursday 27th. We don't have long to convince, but we start to be a bit broken in.

Between the initial plan, the modifications of summaries, the slides reviewed, then corrected, then rewritten, the rehearsals, it took us 4 full days to work on it: the public and the stake are not the same!

ICCARRE is a clinical concept. At Pasteur, they are a bit virginal, but not at the Salpétrière!

A large audience

A presentation by Leibowitch, that attracts! And there, you had the bench and the back bench of the whole Salpêtrière, clinicians, virologists, interns, externs, employees of the industry(sic). In short, it was anything but intimate. If some people had come for the clash, they still got it, a little!

We had come with our die-hard supporters, and fortunately! We were playing outside. On the Salpé side, at least fifty white coats: it's the biggest hospital and university center in France! (of Europe?)

Well, for the atmosphere, let's say frankly that we were received with professionalism and courtesy. This is important because the debate was intense, and the firm organization of the speech a perilous exercise and, let us say it, successful.

Presentation in three parts: Leibo, Ch-E, Leibo

The presentations will be online soon. You too will be entitled to the content.

Leibowitch started with a trick: he won't say a word about 4/7, it's a done deal, and that's not the point. He presents his clinical cases: there are a good fifty patients at 2/7 (including twenty at 1/7). That's a good picture!

Then he passes the floor to me for a mini-presentation: Dynamic Remission and Omnibus: Showing that the Eclipse exists, its dynamics, introducing dynamic remission and the (new) notion of Distance, OMNIBUS and our projects.

As you will have the slides and the topos, I won't go into too much detail... OMNIBUS? It's a validation test of the 2/7 followed by an exploration of the best synergies.

Then Leibo takes the floor again to make the case that it's time for distinguished clinicians to take over. At almost 85 years old(he says... ), he wants to pass the baton. So it's up to you to step up to the plate.

A passing exam

The reader must understand that we are dealing with experienced clinicians. You mess up on an argument, and you're finished... I know my subject well, but not everything, and they ... Yes, I do...

I mention the Visconti... And then Prof. Katlama interrupts me to ask me to define what the Viscontis are, in case there are people in the audience who don't know. Well, I'm doing pretty well, and I'll put the nail in the coffin: all attempts to recreate Viscontis (e.g. SPARTAC trial) have failed. As in the circus, the gladiators test themselves.

Small point of semantics

I mentioned that from now on we would call 'dynamic remission' what is at 1/7 (or even better), and nobody noticed... It seems to pass.

Since there are now so many proposals on the table, it was agreed to call from now on what has less molecules and intermittence, the x/7. Yes, because otherwise it is confusing! We learn, in passing, that the Salpé has about fifty patients on Mono-DTG, without any problem...

A lively debate, stormy at times, and an ultra positive conclusion

Under the firm direction of Prof. Caumes, Prof. Katlama takes over. Well... She is in front of her troops, so she paints us a pro domo picture, where the Salpé is portrayed as a proactive actor: 1/3 of patients are on lighter prescriptions. Well... We came to give the keys of the city to Caesar, so it's in the right order...

There are still some who are bothered by ICCARRE-le-Grand. Virology is the first one to shoot, and the reservoir's patati and patata. I'm taking out my public challenge: prove, by a contingency table, that total DNA is a predictor of the Eclipse's closure. I know there isn't one... But then, Katlama, reports that in MONOI there was only one real failure, but a few blippers, in whom there was a small reservoir effect, which is normal and expected, according to her.
No need to raise. That doesn't answer my challenge... Especially since she could have used her ULTRASTOP test, which she didn't do, and which reinforces my idea that there was little argument to be found there... Huh? Well... Now we've kicked you out of the total DNA with a big kick in the pants.

Roland Tubiana noted that I had presented advantageous openings of the Eclipse, measured in very early treated patients, with low reservoir. This is factually correct! We don't point out, because in fact, we can't do anything about it... The tendency, among the few clinicians who do analytical interruptions, is to choose favorable patients a priori, so as not to get too bored... We don't have recent values on 'broken arms', but we have 20,000 weeks at 2/7 (or even 1/7)! That's 20.000 eclipses, of at least 1 week, repeatedly!
So as long as the eclipse is of more than one week, whether it is of 7, 15, 21 days, we don't care a bit, for the subject of the day.

Then he laid out a known speculation, that even below the threshold of undetectability, things might be happening and that, well, there you go, that might sustain some replication and inflammation, what do I know.... What do I know, indeed... It's Nessie, the Loch Ness monster, we've never seen anything, never proven anything... It is purely speculative...

So it's a bit annoying, for nothing... But well... Leibo, he likes to show off, and the young interns who dreamed of a clash have been served. It's even better than at Bourdin or Ruquier. And then, it was the language of a rifleman! Well... Let us pass...

In fact, the bottom line is that Katlama, the story of an OMNIBUS trial at 2/7, likes it... That's it! We had plenty of marbles, arguments, pleas, but, in fact, useless: OMNIBUS pleased!

We had presented it in broad strokes, so she asked us to refine our project.
That was all! It lasted an hour, and it was agreed that we would refine OMNIBUS, and follow the usual path.

A success... I'm proud of it!

For a success, it is a success. Since it was bibi who presented it, I was a bit surprised: it went through like a charm(well... it will do... ). Well, after 4 days of preparing a nice shot in the cage, it took me 3 days to recover!

I'm exhausted... More in the next issue!

Have a good weekend, good stuffing and not too many meds... Right?

114

This was originally published here, in French (link).
We provide this translation for your convenience. Practical aspects may differ where you live.



Misconceptions 2018

By Charles-Edouard!

Hello Charles,

I see your testimonial where you say you blew your copy counter and lost 500 CD4s. Quite surprising, how do you explain it?

It was a trial with DTG 150 mg, 1 day out of 7: the rest in a future post... Don't worry... I became undetectable again quickly and my CD4 came back to 950 immediately (after a step at 700)
In my case, the CD4 count is yo-yoing: sometimes I lose (or gain) 300-400 CD4 even in stable periods, while keeping a rather stable percentage... The blood counting machine does not count CD4, no... It counts the lymphocytes and determines the percentage, then it simply multiplies it. When you are in the high percentages, the slightest fluctuation in the total number of lymphocytes, arithmetically, causes a big fluctuation in the count. One day I will do a paper on the subject: the fluctuation is natural, and it is the absence of fluctuation that is not...

Misconceptions 2018

Whether writing The Book or preparing for our conferences, I find that I have to fight a bit of the same ideas that are at the root of excessive and unnecessary over-medication. These ideas, promoted by a corrupt system, end up being an obstacle to research and to a better quality of life. Just like the list of doctors or drugs, I want to make a list, to comment it and to see what changes from year to year...

The opportunity is given to me by the appearance on youtube of such an attempt to drown the judgment of the patients in an endless, useless and especially... false logorrhea.

Of course, there is no lack of misconceptions around the world: religion, homeopathy, integrative medicine, Keynesianism, the European 'nation', creationism, cholesterol, etc. It is even fun to dissect them. It is even fun to dissect, with precision, in order not to be accused of conspiracy or arrogance, which are the tricks liars use when they are pushed to their limits...

How to spot a misconception in modern medicine

All this junk is not medical in the noble sense and is treated as risk management, something people do on a daily basis, sometimes like Mr Jourdain, without knowing it.

Philosophers have developed Logic to serve as a tool. Now, we must be open to other tools. For the most banal deceptions, Atlantis, the black cat, etc., follow Michael Shremer who reviews the bullshit detection kit. In modern medicine, we have a wonderful tool: the contingency table, well explained at the beginning of this video.

In all circumstances, ask for the confusion table (see Wikipedia)

List of misconceptions

Here is a list of common ideas that we will see how (or if) they are invalidated:
Pharmacokinetics, Total Proviral DNA, Abusive Indication Extension, Achilles Heel, Bombology, Honesty of Scientists, that will be plenty for today...

Chance, you can go and watch this ultimate of stipendiated deception that is HIVonAir, and I even recommend this episode Is it possible to eradicate HIV from the body of an infected individual? by Dr Laurent Hocqueloux , Dr Anne-Geneviève Marcelin , Dr Gilles Peytavin , Pr Gilles Pialoux

Here we see Pharmacokinetics (Dr Gilles Peytavin) and Virology (tanks, Dr Anne-Geneviève Marcelin) summoned to the debate on the question of remission, displaying their knowledge, without advancing things one iota!

What is (total) remission? It is an eclipse that does not close! So any discussion about remission is a discussion about the closing of the Eclipse(its opening, at CV < 50, is a given, it opens every time)

Pharmacokinetics: it's pathetic

Pharmacokinetics is a useful science, when invoked properly! Since the Eclipse lasts on average 14-21 days, starts with a 1-2 day pharmacokinetic extinction phase, explain to me how pharmacokinetics has a role to play in the end of the eclipse? It's impossible because, from the middle of the Eclipse, there is nothing left! And if someone insists, insist on a confusion table where PK is able to predict anything about the end of the Eclipse: This is the public challenge to Gilles Peytavin: show, by a confusion table, that PK is involved in the end of the pharmacodynamic window (the Eclipse).

And if you can't do it, please go back to your studies and don't bother the debate anymore: it' s pathetic.

We don't care whether a viremia leaks into the sperm a little, a very little or a very little: this is the strength of the Swiss statement, clinically confirmedto affirm the non-infectivity, notwithstanding the possible presence of viremia in the semenso we don't care. And it has nothing to do with the closing of the Eclipse! Goodbye Berthe!

Proviral DNA: off the track

Rouzioux has been pumping the air for more than a decade to make us believe that proviral DNA is predictive of anything. She recently added another layer here: this marker is easy to use, precise, specific, practical, robust and reproducible. Let's comment: easy to use(yes, so what?), accurate(oh really? +/- 1 log , is that accurate?), specific(of what? with more than 95% of Junk, unable to replicate, it is specific of what?), practical(yes, so what? practical if it doesn't bring anything, what's the point?), robust(well, come on! prove it!) and reproducible(yes... it's also a characteristic of systematic errors to be reproducible). A good measurement must be accurate, faithful and sensitive: but this thing has no sensitivity! You might as well weigh a coin with a weighbridge!

This is what Anne-Geneviève Marcelin demonstrates with her onion diagram, which must be read with a Log scale in your head

By the way, ask for the confusion table: in ICCARRE 1/7, ANRS-4D, SEARCH 019 it is impossible to establish! To be a predictor of failure in short or ultra short cycles, there would have to be failures! Oh yes, it is a poor predictor in an equally poor alleviation: the Mono-IP. How does Mono-IP contribute to the remission effort?

This is the public challenge to Anne-Geneviève Marcelin: show, by a confusion table, that the total proviral DNA measurement anticipates the end of the pharmacodynamic window (the Eclipse). And, if not, go back to your studies, without stuffing us any more. Thank you very much...

Well... You remember the famous 'Rouzioux criteria': not one of them has withstood ANRS-4D: laminated. So, we hope not to see it again on our screens!

the Abusive Indication Extension: inexcusable torture

The U=U is a valid argument to present to the patient who is reluctant to enter treatment, in the absence of even mild immunosuppression (CD4 > 350). And if this is not a concern, it is criminal to impose a treatment without demonstrated benefit.

The START trial, where all the excess morbidity occurs in the countries of the South, whose sanitary conditions have no comparison with those of the North(go and catch tuberculosis in Sweden or a fatal salmonellosis in France, it's ridiculous!), demonstrates, contrary to the vulgate, that the over-risk in the North is null: indeed the over-risk is exactly proportional to the real over-risk in the South (TREMPANO) and the null over-risk in the North(HIV-CAUSAL)

Here again ask for the confusion table! That of the North, of course! The risk in our over-aseptised countries is out of all proportion to that in Zimbabwe(who would be stupid enough to believe it?).

You are promised a better immune restoration to enter the treatment (too) early: here too, demand the confusion table! Yes, the confusion table! Because no one ever gives it! And for good reason!

The Achilles heel: a concept to be invalidated

The Achilles' heel(I named it that) is a weakness in DTG induced by the previous use of RAL or EVG. This risk factor is amply confirmed (BMM+P cohort) and even confirmed(sic), a little late, it is true, by the authors of DOMONO!(resic). So it is not a false idea! But it is a not very specific predictor. Sensitive, but not very specific. It is a predictor that can be read in the patient's file. Yes, it is. But the virus doesn't have a periscope to read, over the virologist's shoulder, what is in the file! It only knows how to 'read' DNA. The day we will also be able to read and predict, with more specificity, that day, the Achilles' heel will be obsolete. Until then, it remains the best we have! But you still have to take the trouble to read the file... Hein Hoqueloux, you've been fooled on this one...

Bombology: we just have an embryo

When the Eclipse closes, it is the end of the mini-remission. It closes around 14-21 days. , on average. For some 7 days, 30 days for others. Therefore, at 1/7, we are in no-failure mode, and who cares about having a predictor? At 1/7 we are in the white zone, the comfort zone. As the search for dynamic remission is a Darwinian process, when the patient's rhythm changes from 1/7 to 1/10, 1/15, etc., we will eventually enter the grey zone. And there, looking for a predictor makes sense.
Well... At 1/7, pharmacokinetics is in the toilet... I get it... Measuring the reservoir has a very small chance, very small unless you use another method than proviral DNA, as easy as useless... Achilles? We don't really care... Mono-DTG for 1/15??? I don't feel it... But well, the proposal exists, so we'll see. There is still the 'Science of Bombs': in Choke-and-Mute, we vitrify the system with a mega-bomb, and then we take advantage of the Eclipse. How to build a mega-bomb? A weak bi (DTG/3TC) a concrete bi(DTG/XXX, I'll come back to that soon), an unexpected TRI (NVP/DTG/X), the patented Quadri, the Dodecatherapy(I'll come back to that soon)? There is bound to be something that is better than another. In any case, Isentress®, we don't feel it... Kaletra® ??? It's not a done deal!

So for the moment Bombology, the 'Science' of the best synergies, is a bit of alchemy. We are already lucky that the Leibo patent works, but if we no longer have Videx® or if we are allergic to Abacavir, we have to find something else!

So Bombology is a technique to be developed, we need people, ideas, money and volunteers(in large numbers), we will get there. And then, one day, someone will come up with a concept that will invalidate this trial and error research.
So, it's not a bad idea, but we'll have to do it right...

I forgot about Septism: what was I thinking???

It's true that with the announced success of Quatuor, we just forgot that this nonsense had also made its time. We will develop in 2019...

The honesty of scientists? In this mercantile era ???

Here again, if you are not already disillusioned, watch again HivOnAir® or the Rouzioux video! It's so distressing that you could cry. Everyone has their own little ditty, the one they know, the one they get paid for. Look at how Peytavin embarrasses even his own colleagues in this golden galley! He can only tell you about what he knows. But is it relevant to the case? No! Then it's talk for nothing. The mistake is not Peytavin, as a person, the problem is to summon him to a debate where he has not contributed anything. But this choice is not trivial: it is motivated.

So, to see the patients, in suffering, being bamboozled in this way, yes, it is sad... The honesty of scientists? A misconception!!!

In the news

- U.S.: 72,000 people died of overdoses in 2017, a record. It's the opioid crisis... And who is it that put this on the market? And who's the one who authorized it? And who is it that prescribed them? You criminals!

- Oh, this is not recent, but the subject is fascinating: When Snails Attack: The Epic Discovery Of An Ecological Phenomenon

The French genius

The genius of the week is Charles-Edouard! You are never better served than by yourself... Honestly, I had a great time watching this conference at Pasteur!
It is now available on YouTube. That's it! We know how to do it too!

Video in 3 pieces:
Part 1
Part 2
Part 3
And the: Verbatim

Otherwise, have a nice time with the choristers, on video: a treat...

Don't hesitate to comment, like, share and use

97% of patients overmedicated, 22 million without treatment... Let's stop this scandal!