As physicians we are often asked to be your source of knowledge, to sift through the medical nonsense spewed out by alleged "experts," by the media, and by drug company ads and tell you the truth. Sadly, especially during COVID, but pretty much for my entire career, doctors receive an F in this regard. Doctors rarely critically read and understand studies, they often simply are parrots for what their medical societies, drug company protocols, or media pundits spit out. It is said that only about 10% of doctors truly understand the risks and benefits of what they insist patients pursue, while they think they know 90%. That is a dangerous failing, and it has hit hard during COVID.
Many of our patients ask why we don't use drugs like Paxlovid. It's because we've done our research, because we are inherently skeptical about miracle treatments that have not been adequately tested on a vulnerable population, and it's because there are much more tried and true treatments out there for COVID that have saved hundreds of thousands of lives and that we know do work. Why risk an experimental drug when treatments exist that are known to be safe and effective? Why treat a virus at all when the treatment may well be more dangerous than the virus?
We have compiled a Paxlovid fact sheet, that is below. This drug was approved by weak emergency authorization standards in a study conducted by Pfizer that looked at a few dozen patients who fit a certain profile: they are unvaccinated, they are on no other medicines, and they have no other medical problems. In that selective group there was a tiny but measurable benefit to taking the drug, but Paxlovid wasn't compared to other drugs that we know are effective (such as prednisone and Zithromax) nor were the benefits of definite clinical significance. Most importantly, the people this drug was tested on are completely unlike anyone who is reading this blog. Why didn't they test it on real people? Drug companies aren't that dumb. They do small studies first, find out who will be harmed by their drugs, and exclude those people from studies. In the case of paxlovid, this includes anyone who is elderly and on medicine and who has had a vaccine.
Look, drug companies have a recipe that has worked well for them to convince docs to use their products. First, they scare you, they tell you that unless you take their product you will get sick and die. Second, they test their drugs on small groups of people and then tell everyone to take them, suppressing any information about side effects. Third, they advertise the heck out of the drugs and pay doctors to endorse them. Such is the case with paxlovid.
Why do we need expensive anti-viral treatments? After decades of using them for flu (mostly Tamiflu), we know they don't work. They don't make people feel better, they don't prevent hospitalization, and they don't prevent death. And on top of that, they have serious side effects as people age. When we started using anti-virals for COVID, mostly remdesivir, early studies touted great benefit, but reality painted a more grim picture. These IV anti-virals are felt to have killed tens of thousands of people, most of whom are elderly. Imagine going to the hospital with COVID and then being killed by the treatment that the hospital gives you. That's the case with these drugs, and the fact doctors are still using them even in our local hospital is medically negligent.
Paxlovid is just like remdesivir. Same mechanism of action. Same results. That President Biden and Anthony Fauci had major reactions to Paxlovid and still endorse it, that tens of thousands of people have had reactions and experts are still telling people to take it, is a violation of the Hippocratic Oath. First do no harm. We adhere to that precept at PPC. That's why we don't give Paxlovid.
In the elderly, Paxlovid interacts with a huge number of medicines, causing severe drug reactions. It causes recurrent infection and prevents people from eliminating virus. It makes people feel ill. And most importantly, it doesn't work.
A recent study out of Israel seemed to validate the efficacy of Paxlovid. Many doctors after reading this study (or, more accurately, reading the headlines and the media presentation of the study, because clearly they didn't read the study) told me I had to reconsider my view of this dangerous medicine. The study showed that Paxlovid reduced death by 80% and reduced hospitalization by 70%. You can't argue with those numbers! I mean, wow! But then I did something that my doctor colleagues hadn't done, that virtually no doctors do. I read the article and studied it.
I wrote about this on a blog in my personal site, but here's the short version:
The 80% reduction in death translates into a less impressive actual number: out of 1000 people who received Paxlovid compared to 1000 who didn't, 3 lives were saved. That's a benefit of 0.3%
The 70% reduction in hospitalization was even more puny. Out of 10,000 people who took Paxlovid, only 4 hospitalizations were averted. That's a benefit of 0.04%.
The study was retrospective; it looked at a group of people hospitalized for COVID and divided those who took Paxlovid from those who didn't. It didn't control for any variables regarding who took Paxlovid (were they younger, healthier, on other drugs that helped them, less likely to die of COVID) and didn't try to figure out if Pavlovid actually helped people or if the people who took Paxlovid were less at risk. This is crucial, since about 80% of retrospective studies are reversed and find just the opposite of their conclusions once more rigorous criteria are applied.
Most disturbing is that most people who don't take Paxlovid are more ill. That's because Paxlovid can't be given to people who are on certain drugs. Thus, in this study, the group of people who didn't take Paxlovid probably had far more chronic illness (heart disease, diabetes, lung disease, were older, ect) than those who took Paxlovid because the drugs they took for their medical conditions made them unable to take Paxlovid. Hence the 3/1000 people who lived longer likely didn't live longer because they took Paxlovid, but because they had less underlying illness.
Once these variables are taken into account, it is very likely that the numbers will reverse and that more people will have died who took Paxlovid than those who didn't.
At PPC we are going to wait for someone to conduct a robust prospective randomized trial before we pass out this snake oil to our patients. Why aren't they already conducting such a trial? That's easy! Why should Pfizer do any more research when its compliant medical peons are prescribing billions of dollars of Paxlovid already?
As Olser said, don't use medicines unless we're sure they have proven benefit and little risk. Paxlovid is just the opposite. We've treated hundreds of elders with COVID. The outcomes of our patients is substantially better than the national average, and essentially most of the patients we have lost either were end-stage even before COVID hit them, or they went to the hospital and received dangerous medicines like Paxlovid. Our patients do well because we care enough about them to make sure we're not hurting them with our cure.
Our goal at PPC is to be the filter between the declarations of misled "experts" (who often have a conflict of interest with Big Pharma or no academic discipline to actually read studies) and medical truth. Almost always, new poorly studied drugs should be avoided. Paxlovid is one such drug. It is potentially dangerous, interacts with many common medicines, and it's ineffective. We won't let our patients fall into the Paxlovid trap.