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The Man Behind #LancetGate: A Breaking Science Scandal with Global Ramifications · James Todaro, MD


NEWS REPORTER: A medical journal has announced that it is retracting a study, a published study on the drug hydroxychloroquine This is the anti-malaria drug that everyone knows about that the president touted as a good treatment for COVID-19

One of those studies published in The Lancet , they are now retracting that at the request of, as I understand it, the individuals who published the study What's going on? Why did the individuals and The Lancet lose faith in this study and what does it mean because we're talking about I think two attractions: The Lancet and another publication But there were are also other studies on this drug too Geoff: Hey everyone Welcome to the H

VMN podcast This is your host Geoffrey Woo Hope you're all safe and well

There's a lot of new stories going on in the world today but I think one of the more interesting and very important new stories was in part sparked by my guest today His name is Dr James Todaro If you've heard anything about hydroxychloroquine, Lancet Gate, this gentleman was part of the center of that storm and excited to have you on the program Dr

Todaro: Thanks for having me Geoff Geoff: How are you doing? I mean let's just touch base on a human front for a quick second before diving into this story in the meet here Is family well, safe, healthy? Dr Todaro: Yes We're doing very well

Here in Michigan actually that's where I am, as in Michigan Restaurants are just starting to open up I was actually crazy though, I just had a baby about six weeks ago So it's really during the center of the pandemic And so, we are actually – early on, it looked like this was going to get worse and hospital systems were going to be short-staffed and everything

We actually decided to have the baby at home There was a midwife present but I actually delivered the baby here and she's healthy and everything but it's a little interesting twist to the pandemic in addition to all this research that I've been doing Geoff: Congratulations Yes It sounds like the MD, medical doctor training

Although I don't think OB-GYN seems like it played into good use there Dr Todaro: It's been a long time since I've delivered a baby, since medical school Geoff: Yes So, for folks who are tuning into the broad story that Dr

Todaro is involved with, you've probably heard about hydroxychloroquine, how it might have application for COVID-19 and of course all the political spin with Trump being super for it and drawing in WHO, CDC the whole, I would say, drama or the politicization or the institutionalization of what folks are trying to see from the data and the ground up Perhaps I'll just give context of what has happened in the last week here with the withdrawal of a couple of key studies that have dictated how government and international organizations have treated hydroxychloroquine

Can we give the intro wedge into that story and we'll start from there Dr Todaro: Yes So I've been following COVID-19 since January It looked like it was going to be a highly infectious virus that was going to be leaving China and coming to Europe and the US and I was doing a lot of research on it and that's when I kind of, working with a colleague, came up with the proposition of using chloroquine that's closely related derivative, hydroxychloroquine as a potential treatment for Corona virus

So we published that paper in mid March, March 13, after Elon Musk tweeted it out It was widely disseminated, got millions of views and my colleague went on Fox News a couple times to discuss it and then once the president discussed an [?] and tweeted it out, it became probably one of the hottest controversies of this pandemic It really inspired the medication that divides people the most in addition to a number of the other recommendations made by the CDC and World Health Organization Obviously since we released that paper, I've been closely following hydroxychloroquine I know just about every single study that's come out about it, both the benefits, potential benefits of this therapy as well as the risks or potential harms

When the Lancet study came out, it was very interesting to me because it didn't really line up with the research that I had been seeing about hydroxychloroquine Geoff: 100% Then for folks who don't necessarily follow medical journals, Lancet is essentially the Gucci ,the Louis Vuitton of medical journals All the top policymakers probably are reading this and really take their policy decision-making from research being published and essentially certified by Lancet So, what exactly was that study and what clued you in specifically on the potential fishiness of the raw data there? Dr

Todaro: Yes So to amplify your point, the Lancet is a 200 year old journal It's either the first or second most prestigious medical journal out there So, basically if something is published and it makes it to the peer review process for The Lancet, physicians and healthcare professionals essentially look at it as – it's almost like God's word of medicine The lancer study was supposedly a multinational observational analysis, about 96,000 hospitalized COVID-19 patients

So, massive, massive database that collected data all the way from December into about mid-April on these patients and what they're specifically looking at was how these patients did when treated with either hydroxychloroquine or chloroquine plus a macrolide Which a macrolide, the one you're probably most familiar with is azithromycin So it's an antibiotic but also can have some anti-inflammatory, antiviral properties as well Geoff: Sorry to interject you and that was the combination that President Trump used prophylactically in recent weeks, correct? Dr Todaro: So prophylactic regimen is a little bit different from the treatment regimen which actually also I think affected the most recent New England Journal of Medicine study

They came out looking at it as prophylactic, but prophylactic is for – There's two different types of prophylaxis It's called Pre-exposure prophylaxis and post exposure prophylaxis and Trump was taking the medication as post exposure prophylaxis There's someone that he came in contact with, I think maybe even two people at the White House who were later discovered to have been infected with Corona virus and so he took I believe a single dose of azithromycin as well as zinc and then hydroxychloroquine So, the hydroxychloroquine he continued throughout a two-week course because by that point if you hadn't been infected with the Corona virus, then it's unlikely that it was going to so the initial dose of azithromycin is probably just to combat that one early dose to maybe give you a little boost but that is a little bit more controversial with less research on post exposure prophylaxis with azithromycin

I'd say the mainstay of his regimen was the hydroxychloroquine Geoff: Got it I just wanted to just tease in with folks that might have seen azithromycin associate with hydroxychloroquine for they might have heard that or they might have seen that Dr Todaro: But that is the original regimen

So that's the regimen that was first studied in the South of France by Dr Didier Raoult and that's what he showed effectiveness in his clinical treatment of patients and so that's why that has been such a studied regimen I would say over the past couple months Can I get back to the study? So what they discovered was to me shocking, not shocking to a lot of the mainstream media who had been saying remember all along, essentially since we came up with this paper that hydroxychloroquine will harm you, it's got a lot of risks particularly from the cardiac side of things, where it could give you a heart attack, it can cause you to go into arrhythmias So, when this study came out, it was very quickly embraced by a lot of mainstream media as supporting what they've been saying for a while and if you followed the news at all when the president was taking this medication as a prophylaxis, there was a lot of negative attention on how dangerous this was and irresponsible this was of him to do this The study came out and actually showed that you had twice the risk of dying from COVID-19 if you were treated with hydroxychloroquine or chloroquine

So this isn't just saying that there is no benefit to this medication They were actually saying you are more likely to die, significantly more likely to die, if you get treated with this as opposed to not treated with it and then as a secondary outcome, it showed that you are at a higher risk of developing a cardiac arrhythmia, so your heart rhythm would be basically thrown out of whack That was really shocking to me One thing that I've been saying since March is that hydroxychloroquine very, very likely has no effect, no benefit if used late in treatment of COVID-19 By that point, you have such a systemic inflammatory response to this disease, you potentially have cytokine storm, you have maybe a raging pneumonia and it's unlikely that hydroxychloroquine will help you

So the fact that the study came out showing that the results showed no benefit, I'd be more inclined to believe them, but it came out actually showing that it's harmful and that didn't quite make sense That didn’t makes sense to Dr Raoult, Dr Zelenko and a lot of other independent researchers like myself around the world who were studying the results of The Lancet study What was very interesting was how quickly this study resulted in changing treatment policies or guidelines all around the world

The World Health Organization reviewed this study for a short weekend so a study came out May 22nd on a Friday, by May 25th Monday, the World Health Organization halted all of its clinical trials of hydroxychloroquine in about 17 different countries I believe and was discouraging physicians and global leaders from using hydroxychloroquine really at all in treatment or prophylaxis of COVID-19 This is probably the study that had maybe the most real-world impact on how physicians are treating patients with COVID-19 The way the study presented the data, it was very much a large data set and they grouped each population of patients by continent Not by country but actually by continent So, you had North America, Europe, you had Australia

So, this was I think, now looking back, a way to try to hide the data as much as possible but Australia is unique because it's both a country and a continent And so, that was where the first red flag of the data surfaced and what we learned by just very simply matching the total number of COVID-19 deaths in Australia by the end of that study data collection period showed that the study was reporting more deaths that there even were in Australia at that time People have been talking about it on Twitter and then the Guardian put out a report, really specifically talking about Australia and the authors of the study very quickly corrected this and said, “Oh, well, it was just a designated in one of the hospitals to the wrong continent and is supposed to be Asia but we said it was in Australia

” The conclusion does not change and they publish this formulate to The Lancet and essentially a way to I think just dismiss this inconsistency with the data At that point, that's a very large red flag for me and they were still refusing to release the data set or let independent researchers look at the – not quite the raw data, but even to know how many hospitals where data was collected from in each country The more we delve in the data, the more it didn't quite make sense The data they were reporting from Africa was really data that is supposedly coming from fairly sophisticated hospital systems in Africa So, supposedly these hospital systems were able to give the authors of the study real-time data so they had to have some type of electronic medical record system to communicate that data

Then the data they were collecting was it was fairly detailed such that it included continuous cardiac monitoring and just most hospitals in Africa aren't equipped and don't do this particularly with COVID-19 which is highly infectious and you're trying to minimize the staff-patient contact So, that was I say, the second red flag with the data The third red flag which I did more digging into was they were reporting 63,000 hospitalized COVID-19 patients in North America The US only had in total about 63,000 hospitalized patients from COVID-19 at that time and then if you want to include Canada and Mexico there's just a couple thousand more from them was probably for both of the US It seemed extremely unlikely, I would say actually impossible that they were able to capture detailed patient data on almost every single hospitalized COVID-19 patient in North America I mean, that's a database that just doesn't exist, particularly in real-time data

Geoff: You'd want that to happen potentially, right? That we could track everyone in real-time in our country That would be an ideal goal but I think folks who actually understand a little about the health systems, we wish we were that efficient We wish we were that organized Dr Todaro: You're exactly right and that would be the holy grail of medical research to be able to have that but realistically, different hospital systems have very different electronic medical records

There's a ton of compliance requirements with this and it hasn't been done yet The authors when they were asked about data they said, “Oh, we can't release the data because it is part of data exchange agreements with these hundreds of hospitals that we have and that all that information is controlled by Surgisphere” So that's when I really said, “Okay, well, you're asking us to trust this data that is actually unbelievably complete you have in this black box” So fine, I'm supposed to trust this Surgisphere company for coming up with solid data Let me look into it At the time I looked into it, there really wasn't much investigative research in Surgisphere So, I have a background, like I said before, I'm a physician, I know how patient databases look, I know how medicine works and then on the other side I'm also a tech investor

So, I evaluate startup tech companies all the time and Surgisphere, their website looked like a startup tech company It did not look like a mature database that was handling, as they said at the time, 240 million patient encounters from 1,200 hospitals in 50 or so different countries It was mostly promotional and the only real research they had on there was there one other study they published in the New England Journal of Medicine about a month earlier They had no team They had buzzwords of a very complicated analytics which included artificial intelligence, machine learning

Geoff: Machine learning, yeah Dr Todaro: Yes, right, exactly

All the buzzwords for a tech company Geoff: Yes Being in Silicon Valley, you hear that you're like, all right, is this some human filtering some stuff or just like – what is this? Dr Todaro: Exactly So to accomplish any of this would require a massive team

It would require senior software engineers, data scientists, physicians, researchers and over a year – months to years, it would be very difficult to put this together There was no mention of really a team besides just the founder The LinkedIn on each of the Surgisphere website just went to the founder Dr Sapan Desai Surgisphere did have a LinkedIn and so you go to the LinkedIn for the corporation, it was really just five people, five employees for Surgisphere that were listed

There was the founder, there was two businessmen who just joined the company about two months earlier One of them still working for a different company, so he was like a part-time thing and then two other, well, they were called science editors One of the science editors is actually a science fiction writer, so I don't know if that counts as science or not but the other science editor actually looks like he passed away I think last year It looks like he was a mentor to Dr Sapan Desai

But before two to three months earlier, it looked like there really wasn't any team besides this one guy And then if you look at the subsidiary companies, because I was like, “Okay, well maybe this is Surgisphere like their head corporation but their subsidiary companies is where they have this big team that's performing all this sophisticated analytics So QuartzClinical is one of the subsidiary companies is most often mentioned and I'm sure you've heard and a lot of people heard but there's a YouTube video out there look like one of those professionally done YouTube videos where it has the founder in the booth, with his booth in the background talking about how great Surgisphere is and then on comes a young woman, the screen comes up with Surgisphere director of sales and she's talking about what they are doing, what they've accomplished at Surgisphere and it actually turns out she's just an adult model for hire Basically the whole picture for the team was that there's no real team It's really just this one guy behind this whole operation and then things even got fishier If you were to check the internet archives, you can't find anything about this company Actually the website was excluded from the Internet Archive which is strange

One thing is for the internet archive's to not have a website like they didn't collect data or collect a snapshot of it, but that's not what it says It was actually somehow intentionally excluded or removed from the archives So, you really can get much history on Surgisphere and what they were saying they were accomplishing or doing even just three months ago Then the last thing that just didn't make sense was how does Dr Desai have this massive database and he's a highly published author? He's published about 39 times in the past five years

Why did he never use this massive database? This database should be a treasure trove for researchers, physicians and everywhere and I would at the bare minimum have used it myself if I were him But there's no real study that came out using this database until April By that point, it was very clear that this was actually not manipulated data but I would say entirely fake fraudulent data And so, that's what I put out in my expose I titled it "A Study Out of Thin Air" and I published that on May 29, twitted it out and it got a good amount of attention and then I think the Guardian came out with a similar story about four or five days later and then it started to hit mainstream media

Geoff: Incredible Dr Todaro: I have a lot of people that send me messages every day that have different tips and things to look into and so I really have to acknowledge those people as well that contributed to that article Geoff: I'm just still digesting the ramifications here where literally WHO, international policy makers have made decisions on something that was so flimsy that you on your part-time day job/hobby of being an independent researcher poking around a lip at the source data and it is so flimsy that it falls apart I think I just want to take this in two directions which is one, let's dive into a little bit of the bias or the appetite for editors of Lancet to so quickly adopt and disseminate something that was so definitive and also just like a really very interesting data set, I think as you mentioned, if one could really have access like that kind of health records database

That's a powerful research tool and curious to talk on one direction why we think the atmosphere on these tastemakers was geared in that one direction Then two, I'd love to talk a little bit more about what is science and how institutional science might be bifurcating of what truly is science and I think if we look at definitions of what science, there's almost opposing force from appeal to authority It's almost a doubt of institutional dogma that drives what is really science which is looking at raw data, running experiments, testing hypotheses So I mean can we speculate a little bit on the motivations and why this played out the way it did? You can imagine that in a more hopefully normal or proper setup here, there will be more checks and balances at the editor level at Lancet and at the policy-making level at WHO, why did James Todaro taking tips from Twitter people blow this out? How could you be the watchdog protecting global health public policy? Dr Todaro: It doesn't make sense, right? ANNOUNCEMENT: We're taking a quick break here for an important announcement

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And so, definitely some politics involved at that highest level Then you also have to look into or consider the idea of big pharma interests They're a very powerful group and there's a lot of conflicts of interest definitely within the US but probably also internationally and with the World Health Organization as well I mean, for the National Task Force who proposes recommendation, treatment guidelines for COVID-19, almost 20% of that advisory panel is either employed or invested in Gilead which is a big pharmaceutical company that has a patent for Remdesivir which many consider a competitor to hydroxychloroquine So, at the highest level, you have really a combination

There's probably a significant overlap between the two of, I'd say big pharma and politics Now the World Health Organization, the chief scientist for the WHO tweeted out I think two or three days ago, this is in regards to the Lancet Study being retracted, that they don't have the time or resources to evaluate the data for every paper and that they just depend basically on the source of the information and in this case it was it was Lancet which is considered a reputable source So here they very quickly, no due diligence I'd say, it was over a weekend, they changed the treatment recommendation worldwide just based off the fact that a study came out of Lancet and involved a Harvard researcher who was well known That was it So that first of all is unbelievable I mean, this wasn't just some random paper that was very peripherally going to affect the treatment patients

This was obviously a very large impact study and so, if you're going to evaluate a study maybe this should have been the one Geoff: Yes This is like the core argument, right? This is the crux argument of making policy Dr Todaro: Then wouldn’t the World Health Organization be aware of a database that was the largest database in the world right now? I mean, wouldn't that be kind of surprising like, “Oh, wow, we didn't realize that there's a real-time artificial intelligence, machine learning database out there that has more patient encounters than any other database in the world

” Like, huh, maybe that will be helpful for this pandemic Like, how could all these not really cross their mind? So, that is very suspicious Then, when you move down to The Lancet, you have Richard Horton who is the editor in chief of The Lancet And he has, I think, talked highly of remdesivir in the past and definitely has his politics that he's tweeted about many times And it's was actually funny, just two days before the paper came out, Richard Horton responded to someone that, another scientist or physician had said that the peer review process was essentially dead

And Richard Horton, this is May 20th, so two days before the study came out, tweeted out saying it's very much alive, it is a very rigorous peer review process with 19 or whatever peer reviewers doing this full-time and how dare you say that And then, two days later they publish a study that get's retracted within 13 days But, so that's another one Geoff: Ironic Dr

Todaro: So, you have the editor in chief who did not think that this data or this study looks suspicious at all Even after the Australia data came back as being impossible, still didn't think it was suspicious Just let the authors respond and then said, "Yeah So, I think that's a little correction, and the rest of it is fine" And then, you go on to the next level which is the actual authors of the study

So, the lead author is Dr Mandeep Mehra And so, he's very well known in cardiovascular journals He actually is the editor-in-chief, I believe, of another well-known journal He supposedly, in the original paper, he and Dr

Amit Patel, another physician who was one of the author of the paper, had access and attested to having access to all the data and reviewed it and tested to its accuracy And what is kind of evolving, which is what I suspected was going to happen, is all this whole scandal was going to just kind of get pinned on one guy which is Sapan Desai with Surgisphere Which is very interesting because, again, like I said, there's so many red flags for the World Health Organization, so many should have been red flags for The Lancet Even for the authors, because Dr Mandeep Mehra who is very familiar with analyzing data as he is the editor-in-chief of another journal, for him to actually do work with Sapan Desai and Amit Patel on this Surgisphere database three times

So, this wasn't like his first time looking at this data, analyzing it They released a preprint in, I think, mid-April on ivermectin using the same database They did that in New England Journal of Medicine article in early May, May 1st, looking at the effects of cardiovascular drugs on Covid-19 And then, with the grand finale of being the hydroxychloroquine study on Covid-19 How, after being that involved for two months or more in this database, would you never been like, maybe I could see the raw data? Maybe ask Sapan like, can I look at the raw data? Or how do I know – This seems like an unrealistic database, is it real? Geoff: Interjecting here, just knowing about the peer review journal submission process, if you are the first author or the corresponding author, you are essentially certifying that you vouch for everything in that paper

I mean, that is what do you disclaim and put in the journal submission; in the paper submission So, just ridiculously negligent at very best to say, "oops, I didn't look at the raw data even though I claimed I did and understand and vouch for everything in this paper" And I think what you are hinting towards, which seems to be a likely explanation, was there a malicious cause or was this a personal greed that explained the motivation here? And is it fair to just put this blame on Dr Desai here, who might be the fall man here How do you digest and encapsulate the different motivations here? Was it just everyone is greedy and want to make a name and the data and the story kind of fit their prejudice lens of how they wanted the hydroxychloroquine sway to play out, and so, every single layer let it slide? And is it just that, just multiple layers in negligence and just a story that fit their own narrative? What do you make of it? Dr

Todaro: I mean, I think you can kind of – if you just look at all the evidence, it just seems unlikely that it could just be negligence all the way through at each layer because remember, this was caught by independent researchers like myself in the matter of days So, one thing would be if this required some maybe government investigation or something much bigger, centralized operation or something to figure out this study, whether it had fraudulent data or if there was more in the gray area But the fact that we, who had arguably significantly less access to data, we were able to see what Dr Mehra is purporting that he was able to see to be able to determine if this study was false It seems unlikely to me

I think that there was something greater going on And then, even if you look at the first interview, Francois A French magazine interviewed Dr Mehra, I think, the day the study came out actually And so, this was when they are riding high, they published this incredible study

And he was speaking on behalf of himself that they started collecting data in real time as early as December on hydroxychloroquine as a treatment for this So, not really retrospectively, but actually, prospectively observing it He didn't say Surgisphere started this or whatever, he was using the "we" I don't know whether he was talking about himself or maybe just referring to Surgisphere, but he was definitely very much embracing his role within this study I don't know

I think there is more to it We probably might never know Some people are definitely calling for a much more formal investigation into this scandal as opposed to just journalistic investigation That might turn up to more details It was funny this past week watching the Surgisphere website and the LinkedIn and everything changed in almost real-time

So, something would come out on twitter and then the website would change accordingly So, it was like all lawyers are looking into these declared partnerships with Harvard and university of Minnesota, and the next day that was removed from the website And then, you had just as recently as today, they deleted their twitter account, and their website now just consists of a "Home" and "About Us" That's really trimmed down And if you – actually, it's very interesting, if you go through the tweets of a lot of these the author's as well as some of the big personalities that jumped on announcing this study, they are all deleted now

And the information is disappearing so quickly that we may never know I don't know Geoff: Yeah One doesn't need a suppose that a potential crime has happened here, but I think in terms of actual – the integrity of the academia of their roles as professors or editors of academic journals with high impact factor, there has to be a formal investigation to just understand how these people have operated and really bring to doubt their previous work I think, it's one of those cases where, okay, there has been a misstep of integrity, negligence at the very, very best, and we need to understand, how deep does that negligence go

Again, at the very, very best if not just more sinister activities that has gone over the years Dr Todaro: Yeah I think that – so, hydroxychloroquine has obviously been a huge controversy And so, that was the only reason this study got so much attention and independent investigation is because it challenged what so many people have been saying for so long

Imagine all the studies that don't have that All the big pharma studies that are published that don't really attract that interest and then, physicians kind of accepted as fact and independent researchers aren't really that motivated to dig through the data or find out whether it's fake or not, yet those studies also make huge differences on treatment of patients and what drugs you use And this definitely calls in a question, I mean, how valid or accurate are those studies? It's interesting because Richard Horton, I think this was about 15 years ago, this is still while he was editor-in-chief of The Lancet, he actually himself said something to the effect of "journals are almost like marketing machines for big pharma now They are almost owned by a big pharma" And that is partially true

That's where they kind of attract a lot of the attention and funding and their papers and stuff And so, I would say that the process is, from what I have seen, it seems like it's been corrupted Geoff: Yeah And I think this draws closer to a lot of the topics that we have to discuss previously on the HV

MN Podcast around how a lot of studies around diet, how a lot of studies around food, nutrition, the stories around insulin resistance, LDL, heart disease, where there is a lot of special interests that are either from pharma or previous dogma that seems to be conflicted with institutional science And I think, one isn't needed to say, hey, there's a massive conspiracy here but I think it is fair to say that – and I think we already see this in other fields that there is increasing doubt around our institutions You see this with journalism, you see a lot of doubt on the individual reporters and what kind of quality of work they do And it's not to say all journalists or New York Times or anything as bad, right? Looks like the Guardian in this specific case and the reporting team there did a great job exposing and educating folks on an important topic here

I see a parallel analog with, for example, folks that are essentially rehabilitating the ketogenic diet Or folks questioning, what is sign [?] care for diabetes Does injecting more insulin make sense if you can restrict carbohydrate? I don't want to go down that rabbit hole

But it seems like in this case, there's this doubt around, what is the rule today given that information access is broader than ever? I think you can make the argument that the academy, 300, 400 years ago, there was just not a lot of access to printed paper, there was a very select few class of people that could have the leisure time to read and ponder science and new ideas and maybe it was fine for the academy to educate and tell people exactly how the world works It just feels like today, there is just a decentralization of information And folks like yourself, you are independent researcher, you have a formal medical training but are not necessarily practicing in the academy, but you are presenting arguments just as, if not sharper and more articulate than the "professional institutionalized research" of the same degree that you have It feels like this is happening across so many different fields today Dr

Todaro: Yeah, for sure I mean, I think it's becoming more and more kind of do your own research as opposed to just trusting some centralized institutions I think that what you are saying, the information is so available and the information flow is there And you can now quickly see and interact with other people's opinions who maybe are not the qualified or not the traditionally qualified people that are speaking on the subject Like before, I would say, social media and the way people are able to interact so easily over the internet, you just had a few of those scientists, a few specialized physicians, and they all kind of know each other were talking intelligently about this subject matter

And that's that But now, you have people like myself And I have a whole network of physicians who have their thoughts on hydroxychloroquine in this And they're not even infectious disease experts, a lot of them aren't in academics, but they have opinions on it, they have very smart opinions on it And the ability to collect in a decentralized way all this kind of intelligence, intel in the subject, I think, it's very powerful

And I think that's why it was possible to actually debunk the study in 13 days I mean, that is probably a record for a study of this magnitude to be able to – from publication to retraction in less than two weeks I mean, it's unbelievable the way that information is all able to be So, some people are looking at the data side of things, some of them are looking at Surgisphere, and then you have that whole track record And then you have these suspicions kind of like what you're saying of institutions

Does The Lancet – they are anti hydroxychloroquine generally before the study even came out Are they suspect? We wrote the World Health Organization, they jumped on this really quickly, is that a suspect I don't want to go down the conspiracy theory too much

I mean, I majored in chemistry in college, I am a physician, so I am all about kind of evidence that's available But there's a reason people got together and looked into this study and is because they are very suspicious about the institutions and what the narrative was they want to spend And those suspicions were correct Geoff: This story here was just the triumph of science, that the academics or the institutions were essentially playing by appeal to authority It's like okay, I got the Harvard researcher, I got The Lancet, I got the WHO, these are the stamps, let's not think too hard

Boom! Policy decided And is actually the scientists and researchers like yourself actually sticking to the principles of science, not necessarily looking at what your institution is or what your degree is but actually looking at the raw data and say, "hey, can you be skeptical here?" And I think that's hopefully one of the things that I've want to do with our program here which is empower yourself, learn so you can actually be armed in this increasingly information confusing world that we have And what are the truths? What are the principles of science? It's not listening to someone with a degree or institution, it's actually, looking at the data yourself and getting the right tools to be able to analyze the data So, I'm curious to hear your thoughts and just stepping back as you're synthesizing all this data where do you now stand on hydroxychloroquine? It sounds like you know, you seemed you know, in the beginning part of this conversation, I think you were open to the fact that it was not necessary proved out one way or the other, what flags you onto this Lancet story was that it seemed very, very negative to the data you've seen Where do you sit today in early June? Dr

Todaro: Yes, so I think there's a lot of confusion on both sides out there on hydroxychloroquine and it really I think comes down to the indications for it It seems like people either say you know, hydroxychloroquine doesn't work, which is what the Lancet study – even though that was just looking at hospitalized patients, we now know it's false and then even the Oxford study that just came out that showed that it had no effect on sick hospitalized patients Again, my followers and a lot of the people that actually conducted the research initially on this, on hydroxychloroquine almost never said this works in hospitalized patients You really have to divide the – if you look at it from prophylactic to late stage treatment, there's you know, before you get infected with the virus, that's called prophylactic, it may or may not work there There's early treatment, which means you've been symptomatic for the disease for maybe two or three days and so, starting treatment with it in that timeframe And then, there's something later stage, where you're hospitalized, you're about to go on a ventilator And so, that's really that last category Is really where most of the research on hydroxychloroquine has been done

That's been the World Health Organization's focus That was the study out of New York, that was their focus And it's really sad because to me it's a waste of time I said it was a waste of time two months ago because it's not going to show any effect that late in the game So, really, the focus should be on either as a prophylactic or an early treatment of Covid-19

And unfortunately, that's where a lot of the data is very limited So, regarding early treatment, really, the best data we have still is from Dr Raoult in the south of France who has treated over 3,000 patients where they're hospitalized but very early treatment before the patients went downhill And he has a very low mortality rate, I think something about 05% or less

And then, Dr Zelenko in New York who's treated over 500 patients now with it This is observational data, this is not a randomized controlled trial, so it's not the gold standard But I would say, that's still the best evidence we have right now on hydroxychloroquine in early treatment of Covid-19 Regarding prophylactic treatment, prophylaxis of Covid-19, there was the Minnesota study that just came out last week

I think a lot of people jumped for buzzwords Even very smart people But it's called a randomized controlled trial and it's published in New England Journal of Medicine So, it was both a randomized controlled trial which is a great buzzword We got a look at what actually that means in the trial

And then, it's published by New England Journal of Medicine So, I obviously I'd havef strong data And so, what that study showed was that there was really no benefit to taking hydroxychloroquine in prophylaxis to prevent you from getting Covid-19 But that study had a lot of limitations which is, it may not be the author's fault It was a very low funded study, which is also interesting of itself

Is why can they get any NIH here or World Health Organization funding for this study? Because they are focusing, those organizations are focusing in and giving money to either big pharma or to studies that don't make any sense But it was an online survey essentially You would say whether you – you would sign up, go online, and say if you got exposed to the virus, and then, they would mail you medication Maybe be a placebo verse the actual hydroxychloroquine But it is pretty easy to tell apart by the size and shape of the pill which one you are taking

And there is really no patient-physician exam So, it was really an online survey at the end of the day And so, I wouldn't call that strong data But it is some data against it being a magic bullet for preventing Covid-19 But I think that ultimately also kind of brings out – in medicine, there's very few things that are an absolute, right? So, it's really more about reducing your chances, benefit over harm

And so, I think that's where hydroxychloroquine stands I think there's a good chance that it helps prevent you from becoming infected If you still get a large viral dose initially, it may overcome the prophylaxis And then, early treatment, I think it can maybe reduce your symptoms or your stay in the hospital and maybe has a mortality benefit as well But I think we are now seeing that it clearly is not actually harmful as the mainstream media was I guess, kind of that was what they were pushing for so long

Geoff: Yeah Let's continue to see how the evidence unfolds I mean, are there devil's advocates who are saying, hey, how is James going to be making money or getting personal gain from hydroxychloroquine being rehabilitated here? Is there something there or is it just like you think that Covid is a problem and you looked at the literature of existing potential therapeutics, hydroxychloroquine came – had a mechanism that you thought was promising and you want to see the work done? Since, I think, we are plain to doubt other people's personal motives, if people put that lens on you, do you say hey, I don't have any conflicts that I know of Happy to take your criticism Dr

Todaro: Yeah So, a few people have asked that It seems like they are asking that more so early on They haven't really been asking any more But which comes like kind of a big problem with hydroxychloroquine is, it was really hard to make money off it

Even Sanofi who is a manufacturer of Plaquenil, so that's the brand-name version of hydroxychloroquine, they kind of just abandoned their recent study on it and they didn't really have a real good reason for abandoning this study But I suspect if they do find it to be effective there's 12 different manufacturers of the drug in the US alone Geoff: It's off pen, right? Dr Todaro: It's off pen It's a 65 year old medication, it's dirt cheap, widely available, and so, any of these pharmaceutical companies that have put in the time and effort to study this drug and the resources, they are not going to get that money back

Maybe all the pharmacies will benefit slightly in some way by selling more of the hydroxychloroquine And it was funny like when President Trump was talking about it, they started looking at his I think investments in Sanofi and stuff And like, oh, he's just looking to prosper off it And I think that even fact checkers one of the [?] he said, well, he's only looking to gain like $100 or something off this Like it's very difficult to make money off this

And so, that's why I think that's why hydroxychloroquine got so much grassroots support Is because people knew that the people are supporting it, I think are a little bit more pure than the people who are supporting advocating remdesivir Remdesivir, I mean, Gilead stock really rises and falls or was for a while based on the each of the kind of leaked outcomes in studies of Covid-19 And actually, when hydroxychloroquine started to get some attention and traction, I think Gilead stock even dropped a little bit which results in loss in millions and millions of dollars for investors And so, yes, overall I would say that there's a lot more trust in people that are talking about hydroxychloroquine over any of the patented regimen because again, it's very hard to make money off it

And I don't see myself making money off it Geoff: No, I think that's helpful I think it's again, I think as we realized that people have potential conflicts I think let's scale out ahead of it I think you're exactly right

This is an interesting intervention And I think we've just seen it We just understand like I don't know if I blame capitalism or incentive structures for why people would rather put money into R&D and doing RCTs which are very, very expensive, unpatented molecules I get it from an incentives perspective, it's very, very hard to say, hey, let's dump a $100, $200,000,000 into an off patent commodity that everyone else will make money off of I think that's where this interesting policy question around, how does science get funded? Because a lot of the profit motive is in therapeutics that are patentable

Are we skewing the focus in a way we don't like? Where does public goods come from? Where does government step in? And I think that's kind of the policy discussion above my pay grade, but I think that is kind of a strolling context that is I think, having all these second, third, fourth, order effects that are driving people locally I don't think any individual researcher at Gilead is trying to say, hey, I am going to like make money and screw the rest of the world on something that's equally or plenty just as good but like ten times cheaper But I think you stack all the systems together and it seems to have some disaligned incentive structures for what should theoretically be a public good versus private profit motive This probably is a good point to start wrapping up the conversation here I know that you have uncensored as your platform where you publish a lot of your early thoughts, taste-making, and drawing attention to this area

Is there other things that you're looking at doing more independent research on? I know this is kind of like your day hobby and you managed investments as your actual profession, but how do you spend your time? How are you allocating your brainpower right now? Dr Todaro: Yes So, a lot of it has been an Covid-19 just because time is of the essence for it And I do balance that time with investments So, I do manage a blockchain cryptocurrency fund and I do continue to do active research

And cryptocurrency, blockchain investments, that's where a lot of my portfolio is right now which is, I think kind of goes along a little bit of the same theme Where it's a little bit of, I would say, almost distrust of centralized institutions again So, just like there is distrust at The Lancet, there's a lot of distrust for banks And the ability to have kind of uncensored thoughts in medicine, that is easily transferable to uncensored money which is like Bitcoin where someone can't stop you from really transacting in Bitcoin They cannot freeze your accounts

It's really money and you have control over And I think that that's powerful with kind of medical information, data as well as money And so, it's kind of a, I guess, a theme All this kind of goes into like one big picture which is kind of uncensored and which is kind of my continual focus A nd I think that on a even higher level, I think censorship is going to be a big, a huge focus over the next few years, and I think we are just starting to see the beginning of it, because so much of intelligent discussion now happens on social media platforms

Twitter is no longer just putting up your breakfast or something, it's very and highly intelligent discussions If you look at that Bitcoin and crypto, all the intelligent discussions that happen publicly are on Twitter If you look at medicine, that's how we kind of came together to debunk this whole study was on Twitter And so, once you begin censoring what people can say and then flagging anything that goes against the World Health Organization or The Lancet, you are going to suppress any of those criticisms that are probably true like this Surgisphere scan I went from, some people are calling it a conspiracy theory to a fact in the matter of days And so, I think it's super important these social platforms remain free for open dialogue and discussion on these subjects

And I really hope that's the case, but I think this is going to be a big kind of battle or war over the next couple years Geoff: I can't agree with you more on that point And I think that's also part of the reason why podcast, long-form conversations, at least we've seen the uplift in traffic and attention and engagement on conversations like these, right? Like even The Guardian article which I think was really nicely done, it quoted you for like a couple sentences and great Maybe the next news cycle hits But I think our listeners and I think folks who have might have read that Guardian article would love to hear an hour discussion into your motivations, your insights, how even came to this point and how it all unfolded

And some of the more speculative future areas to look at which is less understood but potentially require more attention And I think exactly you hit to [?] the nose, I think this to me is like almost the most American concept of speech of meritocracy of ideas not bound by your title or your background or your resume but truly appear meritocracy of ideas And I think that's what we all should be fighting for Dr Todaro: Absolutely

Geoff: And preserving That's the only way you can actually get things right at the end of the day to be effective Dr Todaro: Absolutely Couldn't agree more

Geoff: Well, we'll leave it there Where do people follow you? Where do people tune in to your next insights? Dr Todaro: So, Twitter is where I put a lot of my thoughts at I usually tweet every day It's James Todaro

My last name is spelt, T-O-D-A-R-O, and then MD, medical doctor So, @JamesTodaroMD Follow me there My direct messages are open If you want to reach out to me, do so

I encourage you to do so And then, I also have medicineuncensoredcom, which is where I put out a lot of the kind of content, I guess let’s say real news on Covid-19 and hydroxychloroquine Geoff: Awesome Thanks so much, James

Dr Todaro: All right Thanks so much for having me Geoff: Thank you so much for listening to this week's episode of the HV

MN Podcast If you are interested to learn more about HVM

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