Remembering the massacre that the Chinese government wants the world to forget.
I wrote this last year to mark the 30th anniversary of the Tiananmen Square massacre. One year later the world is a very different place, to a large degree because of the Chinese Communist Party. I believe COVID-19 was developed in a virology laboratory in Hunan and managed to escape. The Chinese government did everything it could to conceal the outbreak instead of being forthcoming about it. One could argue that this constitutes an act of war. In fact I would submit that China has been at war with the United States since shortly after Tiananmen Square. It isn’t being fought by the People’s Liberation Army using conventional weapons of warfare. Instead the Chinese government has been much more subtle in the way it has attacked its enemy. It has waged economic war by intentionally facilitating the devaluation of its currency while it held onto massive reserves of foreign cash. Chinese companies supply all of the precursor chemicals that are used to manufacture fentanyl to the Mexican cartels that make it, with little regard for the consequences. The Chinese have profited greatly from this, but not from an economic point of view. To them fentanyl is a means of causing social disruption and creating a strain on the resources of its enemy.
So as fears of war between the United States and China continue to grow amid the current tensions, the way I see things, a military conflict would simply be the final phase of a war the Chinese Communist Party has been waging for years.
I’m a news nerd going way back, and could probably name more world leaders at the time than a lot of adults. There wasn’t so much children’s television back then as there is today.
The 1980’s was a decade of incredible political and social change across a great swath of the earth, as hundreds of millions of people in different countries began to reject communism en masse. Things were looking shaky politically for communists in the Soviet Union and in eastern Europe, and if the communists were no longer in charge in Moscow, this could lead to it happening in other communist capitals outside the region.
In China, a student uprising in Beijing in 1989 had me believing that change was also imminent in the worlds most populous country. For weeks, news footage from Beijing showed a large and apparently growing mass of student demonstrators in Tiananmen Square. The government had resisted moving in immediately to crush the demonstration, which it surely saw as an insurrection.
When it was over, unknown numbers of people were dead and injured, fired upon by the People’s Liberation Army. Today the Chinese government is trying to erase the Tiananmen Square Massacre from its history. I am doing my part to ensure that history never forgets it.
15 April,1989-The protest begins.
Hu Yaobang, the former Communist Party chief and a leading reformer, dies of a heart attack at the age of 73. Following his death, thousands of pro-democracy protestors, primarily university students, begin to converge on Tiananmen Square. What began as a period of mourning would soon become a protest, as students called for more democratic freedoms.
There was a growing discontent among many students in China, and calls for democratic reform began to rise from them. They wanted an end to one party rule, and more of the democratic freedoms that were being enjoyed in the West.
There was also a demand for more and better economic reforms. The government had begun to allow a very limited form of capitalism within the economy, but an ever growing poor working class was demanding to be heard. Poverty was on the rise and unemployment was a major concern. Students also wanted the education system to be reformed such that they would be prepared for the new and highly regulated free-market style system.
26 April, 1989
As the number of protestorscontinued to grow in Tiananmen Square, there had been surprisingly no efforts to put down the protest. Within the government, two factions were at odds as to how to deal with the situation. The official head of the Communist Party, Zhao Ziyang, is a moderate. his sense is that the demonstrations will eventually dissipate.
Meanwhile, Party hardliners like Li Peng would prefer swift action be taken to end the demonstration, which had by now swelled to tens of thousands of students, all gatherinmg in the square.
But on April 26th, the state-run People’s Daily ran an editorial that would inflame tensions. Titled “The Necessity For A Clear Stand Against Turmoil”, it accused the students of rejecting the Communist Party. The views expressed in the editorial closely mirrored those of Deng Xiaoping, China’s defacto supreme leader.
Still so young and naive.
I hadn’t even reached my 20th birthday yet, and like many I held out hope that China would join the other nations of the world that were shedding communist ideologies. I found some hope in the fact that the protests had gone on for as long as they had without the government cracking down. I was optimistic that the reformist faction withing the government would somehow win the day. I still had a great deal to learn about Chinese politics and culture.
13 May, 1989
Two days before a visit by Soviet leader Mikhail Gorbachev a large number of students go on a hunger strike, frustrated by the government’s unwillingness to open a dialogue with them. The demonstration would cause Gorbachev’s motorcade to avoid Tiananmen Square, and create an embarassment for the Chinese government.
19 May, 1989
34 days after the protests began and knowing that time was running out, Zhao Ziyang went to Tiananmen Square in an unsuccessful effort to broker a compromise with the students. During what would be one of his final political acts, he reportedly told the students “We have come too late.”
20 May, 1989
People’s Liberation Army troops begin moving towards the city centre as the government declared martial law across much of Beijing. As protestors attempt to block their movements, the troops are ordered to hold their fire.
21 May-1 June, 1989
There is no visible security presence in the square over the course of the next ten days. Demonstrations would continue amid a festival like atmosphere, but within 72 hours the mood would change drastically.
2 June, 1989
Senior Communist Party officials approve a plan to end the demonstration once and for all. Force will be used to end the “counter-revolutionary riot”.
4 June, 1989 0100 hrs
As troops begin advancing towards the city centre, protestors have erected barricades to stop them. Armored personnel carriers would be used to break through the barricades, and soldiers began firing at protestors with live ammunition.
By dawn, scores lay dead, and officials began clearing the square. Angered by what they saw, citizens would push their way forward towards the line of troops in one corner of the square. Again gunfire erupted, and more citizens were cut down by their own troops.
Officials would declare the operation a success, but government-run Pekimg Radio English language service would announce defiantly that thousands had been killed in a barbarous suppression of the people, calling it a gross violation of basic human rights.
5 June, 1989
The images that flashed across our T.V. screens that day would be among the most iconic of that generation, and would provide the most famous images to come from the ordeal in Beijing. A solitary man, armed only with what looks to be a bag, places himself squarely in front of an advancing column of tanks.
Viewers around the world watched in awe as the unknown figure, known only as Tank Man, positioned himself in front of the advancing tanks, halting their progress. When they tried moving around him, he moved back in front of them again in one of the most heroic acts of defiance ever captured on video.
Eventually, a figure runs toward the man from off screen, dragging him to safety. Their fate is not known.
9 June, 1989
Deng Xiaoping appeared on T.V. a few days later, praising the military officers who had crushed the counter-revolutionary riot. There is little doubt that China’s senior leader ordered the brutal crackdown which resulted in an untold number of deaths, though the number is thought to be in the thousands.
Path to the current day
China would continue on with the economic reforms that have made it the powerhouse it is today. The Chinese Communist Party will likely never allow for the democratic reforms sought by the students thirty years ago. It is content to reap the economic benefits of capitalism while embracing brutal and dictatorial governance.
While overall wealth in China has greatly increased and a new emerging middle-class has begun ti appear, what continues to remain is the poverty, unemployment, and human rights abuses of thirty years ago. This is not something that China is willing to admit.
The Chinese goverment is trying it’s damnedest to erase the events of thirty years ago from history. It can try to hide the truth from its own citizens all it wants, but we will never let them forget. It’s still an evil regime, only now it has money.
A post appeared on social media late Tuesday evening stating that a sexual assault had occurred in the community of Edgemont, and asked people to be on the look out for the attacker. I messaged the person posting it who told me that a police report had been made that his girlfriend was very traumatized by it.
It happened at 7:40 PM as she was on her way home walking through the Edgemont ravine. The attacker has been described as
a chubby East Indian male approximately 15 or 16 years old
has a mushroom cut hairstyle
wearing black sports jacket, white t-shirt, light wash jeans
He was last seen riding his bike with his helmet hanging on the handlebars.
If you should have any information or you see him please call the Calgary Police Service immediately.
The Phases Involved In Them, And The Regulatory Oversight That Was Intended To Govern Reporting Compliance (But So Far Hasn’t).
As the clinical trials for a treatment and vaccine for COVID-19 continue, the results of concluded studies are being released in the media on an almost daily basis. Last year I wrote a post that explained the processes that are involved in performing these trials as well as the phases of a clinical drug trial. Because trials are now very topical, I decided to republish some information from that post which explains how clinical trials work.
Part two will look at the legislation governing registration and reporting compliance for most clinical trials conducted in the United States. It will also examine the online databases that have detailed information about these trials and the tens of thousands of others conducted in over 200 other countries.
Finally, part three will examine the studies conducted for the antimalarial drugs hydroxychloroquine and mefloquine. These studies will include those for the treatment of COVID-19 along with other off-label uses.
There are no hard and fast rules governing clinical trials, nothing specific as to the required number of participants in a study, and other things of that nature. Clinical trials, in theory, are designed to achieve the best possible result in a best case circumstance. Many times, the circumstances are far from the best case, particularly when it comes to the numbers of subjects (people) that are available to participate in a study.
Typically, there are five phases to a clinical trial, though only four are referred to. The first is referred to as the phase zero clinical trial. These trials are different from other clinical trials in that they are exploratory studies used to speed up the approval process of a new drug, and is usually done on only a few patients. Many times these are investigational drugs and are done in exceptional circumstances.
I’m going to save my self some work and just copy and past this next section on human clinical trials from centerwatch.com.
Phase I studies assess the safety of a drug or device. This initial phase of testing, which can take several months to complete, usually includes a small number of healthy volunteers (20 to 100), who are generally paid for participating in the study. The study is designed to determine the effects of the drug or device on humans including how it is absorbed, metabolized, and excreted. This phase also investigates the side effects that occur as dosage levels are increased. About 70% of experimental drugs pass this phase of testing.
Phase II studies test the efficacy of a drug or device. This second phase of testing can last from several months to two years, and involves up to several hundred patients. Most phase II studies are randomized trials where one group of patients receives the experimental drug, while a second “control” group receives a standard treatment or placebo. Often these studies are “blinded” which means that neither the patients nor the researchers know who has received the experimental drug. This allows investigators to provide the pharmaceutical company and the FDA with comparative information about the relative safety and effectiveness of the new drug. About one-third of experimental drugs successfully complete both Phase I and Phase II studies.
Phase III studies involve randomized and blind testing in several hundred to several thousand patients. This large-scale testing, which can last several years, provides the pharmaceutical company and the FDA with a more thorough understanding of the effectiveness of the drug or device, the benefits and the range of possible adverse reactions. 70% to 90% of drugs that enter Phase III studies successfully complete this phase of testing. Once Phase III is complete, a pharmaceutical company can request FDA approval for marketing the drug.
Phase IV studies, often called Post Marketing Surveillance Trials, are conducted after a drug or device has been approved for consumer sale. Pharmaceutical companies have several objectives at this stage: (1) to compare a drug with other drugs already in the market; (2) to monitor a drug’s long-term effectiveness and impact on a patient’s quality of life; and (3) to determine the cost-effectiveness of a drug therapy relative to other traditional and new therapies. Phase IV studies can result in a drug or device being taken off the market or restrictions of use could be placed on the product depending on the findings in the study.
It’s clear that it would be extremely difficult to perform the perfectly ideal clinical trial, that is just the way things are. This risk goes with every drug on the market, and we take that risk with every dosage of a new medication. It ultimately comes down to a question of whether or not the reward is worth the risk. Sometimes it is, and tragically, sometimes it isn’t.
On January 18, 2017, a regulation came into effect that is called the “Final Rule for Clinical Trials Registration and Results Information Submission” that greatly expanded the requirements for clinical trial registration and results submission for certain trials.
Of particular importance is the post marketing surveillance trial data, which will contain information about any reports of adverse reactions patients have had to a drug. A large number of reports could cause a drug’s approval to be revoked pending further saftey studies, a move which could prove costly to a manufacturer. It is of the upmost importance that these results are submitted on a timely basis, as patient safety is the primary concern, or least it should be. Some companies might be reluctant to release these results because they will be problematic for them, however there are fines that can be levied against companies that do not submit results by the required date.
The statutory maximum penalties under the FD&C Act for committing these prohibited acts are not more than $10,000 for all violations adjudicated in a single proceeding, see section 303(f)(3)(A) of the FD&C Act and, if a violation is not corrected within 30 days following notification of such violation, not more than $10,000 for each day that the violation continues after such period until the violation is corrected, see section 303(f)(3)(B) of the FD&C Act.
In determining the amount of civil money penalty under the relevant statutory limits, the following factors are considered: the nature, circumstances, extent, and gravity of the violation(s) and, with respect to the violator, ability to pay, effect on ability to continue to do business, any history of prior such violations, the degree of culpability and such other matters as justice may require. See section 303(f)(5)(B) of the FD&C Act
Given that a $10,000 fine can be levied for each day a drug company is non-compliant the amount can really add up if it remains so for very long. You might expect this would be an incentive for them to be compliant, however this has not been the case.
The FDAAA Trials Tracker
A team at the University of Oxford have put together a website that tracks the compliance rate of FDA trials, and the results were rather shocking. As of May 28th, 2020, out of 6,567 trials that were reported only 70% were compliant. That means that the results of 1,983 have not been reported. It also keeps track of the number of days a trial is late right from day one and so far the longest is 821 days, and counting.
They are also keeping track of the fines, or rather the potential fines, that the FDA could be assessing. To date that total is over $9.8BILLION dollars however the FDA has not enforced this legislation and has collected ZERO dollars. You can access their website by clicking the link below.
The fact that there are laws on the books somewhere that aren’t being properly applied should come as a surprise to nobody. However, when the health and safety of the public are at risk then there should be absolutely no question as to whether or not a company is fined. The FDA however doesn’t exactly have the best history when it comes to enforcing the laws and regulations under its control.
Canadian clinical drug trials are listed in the ClinicalTrials.gov website however registration is not mandatory, meaning that there could very well be trials conducted in Canada that will not appear on this database.
There is a database that is maintained by Health Canada however, it does not supply nearly the amount of information that ClinicalTrials.gov does, and it is not easy to use. In addition the Clinical Trials Database is not a registry, and therefore, it does not contain comprehensive information about each clinical trial.
You will need to know a lot of information about the study in order to search it in the database, and most of it is information that you must get directly from the study sponsor. According to the website, The sponsor of the clinical trial should be contacted for more information about a trial’s objectives, patient enrolment criteria, potential clinical trial sites, and to confirm the status of a trial. Health Canada will not be providing detailed sponsor contact information, or any other details about the clinical trial, other than what is found in the database. Sponsor contact information should be obtained through an internet search.
In addition to this, there are a few other things that it is very important to know.
Clinical trials in healthy volunteers. Health Canada authorizes clinical trials involving healthy volunteers, such as bioavailability or bioequivalence trials, first-in-human trials (that is, when a new drug is administered for the first time in humans), pharmacokinetic studies, drug-drug interaction studies, etc.; however, information about these trials is not included in the database.
Clinical trials conducted with natural health products and medical devices. Health Canada also authorizes trials involving natural health products and devices; however, information about these trials is not contained within the database at this time.
Phase IV trials. Phase IV trials are studies carried out with a marketed drug under its approved conditions of use, and a CTA is not required to be filed with Health Canada. Therefore, information about these studies is not reviewed by Health Canada prior to the start of the trial, and is not contained within the database.
In 1964 the World Medical Association (WMA) adopted the Declaration of Helsinki which pertains to the ethical treatment of human subjects in medical research. Section 35 and 36 deal with research registration as well as the publication and dissemination of results, specifically:
Section 35 Every research study involving human subjects must be registered in a publicly accessible database before recruitment of the first subject.
Section 36 Researchers, authors, sponsors, editors and publishers all have ethical obligations with regard to the publication and dissemination of the results of research. Researchers have a duty to make publicly available the results of their research on human subjects and are accountable for the completeness and accuracy of their reports. All parties should adhere to accepted guidelines for ethical reporting. Negative and inconclusive as well as positive results must be published or otherwise made publicly available. Sources of funding, institutional affiliations and conflicts of interest must be declared in the publication. Reports of research not in accordance with the principles of this Declaration should not be accepted for publication.
AllTrials is an international initiative aimed at making sure all clinical trials are registered and that the results be made available to the public. There is a petition on their website calling on international governments to act in making sure this gets done and I would encourage you to sign it. It’s about the life and health of you and your loved ones.
It was recently pointed out to me that I haven’t been posting very much in the last while. Apparently there are a few of you who have noticed my absence enough to make mention of it to me (thank you, that means a lot). The fact of the matter is I simply wasn’t capable of writing anything more than a grocery list. The motivation and inspiration I’d had left me completely and my ability to concentrate was all but nonexistent.
It would be fair to say that the mental health of a significant portion of the population at this moment is not at its best. Like millions of others I suffer from depression, and had fought it for decades prior to the arrival of COVID-19 and, like millions of others, the pandemic has taken a significant psychological toll on me. I was in the process of grieving and healing from some personal losses which I had experienced last year when the world changed forever. On Friday, March 13th, and in the days and weeks the followed I began to sink deeper into the all enveloping darkness of hopelessness and despair that accompanies depression. The “black dog” that had hounded Churchill in his life was once again nipping at my heels, and I was finding it very difficult to outrun it.
In the beginning I felt a great deal of disbelief. How had things come to this? Something like this simply wasn’t supposed to happen, and if it were to ever happen it would look a lot different than what was happening. My fear was that there was a very great potential for complete social breakdown to occur here and in the United States. Even if the worst of it was limited to the US, Canada would still feel the effects from our closest neighbour and biggest trading partner.
It was sheer absurdity at the very beginning as the greedy and the panicked turned toilet paper and hand sanitizer into commodities more sought after than oil or precious metals. Then there came the realization that there would be a quarantine and we would be living under lockdown. Soon we were living almost like prisoners in a maximum security facility, or so it would fell to many of us, and I was disquieted by the new lack of mobility that had been imposed upon us. I was by and large a homebody before so it isn’t like I was used to galavanting about or travelling the world or anything like that, but even so it was deeply disturbing to me that my freedom of movement had been taken away. It was something that very few of us could have even envisioned happening, and yet now it was the new reality.
For many the lockdown would become time for a vacation from personal hygiene, so I wasn’t alone in this regard. The same would apply for not wanting to crawl out of bed for days. I was alone and locked up with my thoughts and I would suffer a setback in the grieving process for the two people I lost last year, especially my brother. I missed him terribly, but also I also realized that he would have had a difficult time adjusting to the things that have happened since, and so in that regard it was good that he wasn’t around to see it.
It is often said that humans are very much social creatures, which we are, so the notion of “Social Distancing” can seem almost foreign to some. We soon found out what it was like to not be able to socialize with others in the way that we used to like being together as a group and perhaps even harder still what it’s like to not be able to have physical contact with others. We had to see our families through glass and were unable to give our loved ones a hug at a time when we so very desperately needed to feel one ourselves.
Change of Plans
Change can be one of the biggest stressors in a person’s life. Now a lot of things were going to be changing for people, with little to no warning or time for them to make preparations. There are also a lot of people whose plans for the future were suddenly very much in doubt as a result of this pandemic, myself among them. Hopes and dreams that once seemed attainable were now completely obliterated by circumstance and it was very disheartening to say the least. It has only been in the last few years that I began to discover my purpose in life, that thing that gets me out of bed in the morning. Now it all seemed lost in the enormous shadow of this damned virus.
Eventually I reached the point where I was tired of crying and smelling bad, and so I decided that it was time I dealt with things. Dying simply isn’t an option for me, so it would mean having to deal with this head on and finding a way to live life again. These are some of the things that have helped me along the way, and I thought I would share them in the event they might help someone else.
The Power of Self-Talk
Of all of these tools this is the one that I feel needs to be used first. Being in a negative mindset can be self perpetuating so it is important to actively make an effort to practice positive self talk in order to start having a positive mindset. I can remember scoffing at the idea when it was proposed to me one time by a therapist. I immediately had a vision of myself sitting in front of a mirror like Stuart Smalley (Google if you don’t know who I’m talking about) and telling myself that I was good enough, smart enough, and gosh darn it people like me. But the fact is there is more to it than just a daily affirmation. Negativity breeds negativity, so having a more positive outlook about things will result in a more positive mindset. It’s about constantly talking yourself up in your mind with the ultimate goal of restoring your self-confidence, enabling you to envision victory was once there were only visions of defeat, which leads to victories.
Talk To Someone Else
No doubt mental health professionals are going to be busy for quite some time dealing with the fallout from all of this. I was fortunate because at the time the lockdown started I had been in grief counselling so I had access to someone to talk to about things that were happening with me in the wake of the pandemic.
Not everyone will be in this position though, so they will have other alternatives open to them. In jurisdictions across the US and Canada a variety of mental health supports are available online or over the phone for those that need it, and as always anyone who feels as though they are in danger of harming themselves should call 911 or go directly to the nearest hospital emergency room.
Keep in touch with your network of people be it family, friends, or both. Do a “buddy check” on a friend by calling them to see how they’re doing and the result could prove cathartic for the both of you. Talking about how you are feeling will be an important step towards finding a much needed and therapeutic emotional release.
Establish A Routine
It has been well established in the literature that there are numerous psychological benefits to establishing routines. Importantly, routines and schedules help to alleviate stress and anxiety in times of chaos and uncertainty. They add stability to lives that have been torn assunder and provide a sense of control at a time when we are powerless to do anything in the face of chaos. As the economy begins to open up again many people will find it difficult to go back into “work mode” so getting back into the routine ahead of time will help them to adjust to life back at work again.
Exercise and Nutrition
Diet and exercise are also important components of good mental health, not just physical. Studies have shown that exercising or working out regularly contribute greatly towards the improvement in people with depression. How many people do you suppose gained more than a couple of pounds while in lockdown because of a lack of regular exercise and a diet rich in junk food and take-out? Proper nutrition not only feeds the body but also the brain, so a balanced diet is also essential for good brain health as well.
Find/Maintain Your Purpose
For years various authors and self-help gurus have been charging people a lot of money in order to pass along some wisdom, that is quite simple though perhaps not quite so obvious to a lot of us. Knowing it and acting upon it could mean the difference between life and death for some, and what it boils down to is finding a reason to get out of bed every day. Find a (your) purpose for yourself. If you haven’t yet done so with your life up until this point, now would be a perfect opportunity to start doing some reflecting.
Maybe you had already found that purpose but because of the pandemic it looks as though you might have lost it. It can seem as though you’ve lost your purpose and are now wandering rudderless in rough seas.
It’s important to remember that all might not be lost, it will just be put off for a little while longer than originally planned. Take advantage of this time to retool your original plans, or if you were in need of purpose to begin with, this would also be a good opportunity to do some deep thinking about your life and examine your priorities in light of current events.
The Power Of Prayer
There also really must be something to be said for the power of prayer. I’m not going to tell you who you should pray to or how you should be doing it, just pray. Simple.
To yourself and to others. We’re all going through some shit right now and frankly it would just be nice.
Difficult Days Lie Ahead
Forgive me if this seems negative but the reality is that we are going to be in for some very difficult days ahead, we simply have to accept this and prepare ourselves. That said it’s difficult to prepare for the unknown. What we do know is that people’s mental health will continue to be at increased risk for the forseeable future, especially as the economic impacts of this pandemic become clearer and start hitting home.
With this in mind, maintaining mental health in the face of these challenges will be a difficult road for us all, so it will be important to be as prepared as possible and to have the tools available at your disposal to assist you.
Yet again another Liberal staffer has managed to put both feet in his mouth as The Post Millennial reports Mark Elyas, a federal Liberal riding executive, posted controversial comments on his Facebook page about people who break social distancing rules. He said:
“Shoot people on sight who defy curfews (snipers can be posted anywhere about 2 kilometres from targets. That will kill the spread of the virus and then we can go back to normalThis fool has made other stst
Mark Elyas Facebook Page
This isn’t the first time he’s made foolish statements on Facebook either. In a 2018 post he says “Trump supporters are pieces of shit.”
Wrong on so many levels
I mean where to begin? The fact that he’s calling for the execution of Canadian citizens by snipers? While his boss is bandying about a ban on firearms? This absolutely disgusts me on so many levels too.
Be wary my friends
Governments like to seize opportunities like this to strip citizens of their rights, and it’s happening here in Canada. We need to be extra cautious now, so that we don’t lose any more.
Why Chloroquine Isn’t The Panacea For This Pandemic.
On March 19th, 2020, it had been roughly three months since the first reports of novel coronavirus-2019, COVID-19, began to appear out of Wuhan, China. According to some reports the White House had intelligence of an outbreak in Wuhan as far back as November. In those early days of the outbreak, Donald Trump dismissed any notion that a national and global crisis on a scale never seen before was about to unfold. Then, six days after that Friday the 13th when everything in the world changed, Trump made an announcement that caught everyone by surprise. The antimalarial drug chloroquine would be a “game changer” in the fight against COVID-19 according to the American President.
There has been a great deal made about the fact that there is still not enough data available to state whether or not chloroquine is effective, but I haven’t heard much about the potential adverse events that can and have occurred as a result of chloroquine. This is not a benign substance, it is toxic and potentially dangerous or even deadly in some instances. Therefore a great deal of care must be exercised and all available information about it must be made before anyone can or should make a decision about taking this or any other drug.
I want to make it clear that the reasons for my position on this are by no means political in nature and that they come from scientific and anecdotal information that I have acquired over the course of the last several months.
Available in the United States under the brand name Plaquenil, chloroquine is used as an antimalarial and is also widely used off-label in the treatment of Rheumatoid Arthritis (RA). Not long after Trump’s endorsement, a number of statements about chloroquine began to circulate online with two of the more common being:
The safety profile of chloroquine is well understood from its use in over a billion people for malaria. As you would be aware, despite the similar sounding name, chloroquine is not mefloquine and does not share the same adverse events, and;
A range of national and international organisations such as the World Health Organisation and the Gates Foundation are coordinating worldwide efforts to test these compounds to determine their efficacy.
Unfortunately, both of those statements are false or misleading. Chloroquine is used at similar malaria treatment and prophylaxis dosages as mefloquine. This drug can, in fact, cause severe acute and chronic neuropsychiatric reactions similar to mefloquine, at similar frequency. The military developmental history of this drug in Germany and the United States during the pre and post-WWII era also has a close parallel with the development of mefloquine in the post-Vietnam War era. In addition, exposing medical personnel to chloroquine in high-stress environments during the Covid-19 pandemic would likely exacerbate those stresses and/or confound prompt recognition of the prodromal symptoms of toxic encephalopathy.
In the 1820’s two German scientists were the first to isolate quinine from the bark of the cinchona tree, as the compound that gave the bark its anti-malarial properties.
Quinine is an alkyloid, which are naturally occurring compounds usually found in plants and mostly contain basic nitrogen atoms. Many alkyloids have medicinal purposes and are used to treat a variety of diseases, however they can also be highly toxic to humans. Morphine, strychnine, atropine, colchicine, ephedrine, and nicotine are also alkyloids.
There are also synthetically developed derivatives of quinine such as mefloquine and tafenoquine which were made with the hope that they would be less toxic. However evidence clearly shows that this is simply not the case.
Eventually malaria became resistant to quinine and a replacement would need to be found. This replacement was first synthesized in 1934 by Hans Andersag, a scientist at the Elberfeld laboratories of the Bayer I.G. Farbenindustrie A.G. in Germany, and given the brand name Resochin. In subsequent trials later however it was deemed to be “too toxic for practical use in humans.”
W. Kikuth, of the Elberfeld laboratories, tested Resochin against bird malaria (1935) and found it to be as effective as Atabrine but slightly more toxic. On the basis of the Kikuth tests, the compound was given to F. Sioli who tested it (1935 or 1936) against blood-induced vivax malaria in four paretics at the psychiatric clinic in Dusseldorf. There are no actual records of these tests but he is credited with reporting it, 1) as equally effective as Atabrine, and 2) as saying that it was “too toxic for practical use in humans.” Whatever his conclusions might have been, the report of its slightly greater toxicity over Atabrine in lower animals seems to have been the factor which brought the decision to abandon it. This decision by Bayer. . . may have had merit in terms of the times although later it became known by the Germans as the “Resochin error.”
A less toxic compound, methylated Resochin, was formulated in 1936 under the brand name Sontochin and was given to the Afrikakorps during the war. The drug would find it’s way into Allied hands in Africa after a supply was found by French troops in Tunisia who turned it over to the Americans, which would ultimately lead to the release of chloroquine in 1945.
Potential Adverse Effects
Significant risk of permanent neurological damage
The simple fact is that chloroquine, as with the related drugs tafenoquine and mefloquine, is able to cause severe, chronic toxicity including (but not only) lasting or permanent brain damage. I know this because over the last fourteen or so months I have had the opportunity to talk to a number of veterans whose lives were torn apart after they took one of these drugs, some have had the misfortune of having taken all three of them. The adverse effects that many now suffer include:
psychiatric disorders including depression, anxiety, bipolar disorder and schizophrenia.
cognitive impairments including memory and concentration difficulties.
hearing problems including tinnitus, hearing loss and hyperacuity.
vestibular disorders including dizziness, vertigo and spatial disorientation.
neurological disorders including neuropathies, seizures, Parkinson’s disease
and motor neurone disease (MND)
Although exact numbers are not known, a very significant number of individuals who have taken these drugs have died as a result of either suicide or a motor neuron disorder.
It should be noted that while these incidents may only occur in a minority of people, it is nevertheless a rather significant minority and although these and other adverse events are typically seen with long term use and higher dosages, it is possible and has been known for them to occur after a SINGLE dose.
We present a case of a Mr A, who is 32 years old gentleman with no significant past medical or Psychiatric history. He was admitted in general surgery ward of our tertiary care teaching hospital where he was diagnosed with amoebic liver abscess and underwent management in the form of percutaneous aspiration of pus and received intravenous antibiotics during his stay in the ward. He was discharged on chloroquine phosphate 600 mg in divided doses. After discharge the initial 4 days were uneventful. Since the fifth day Mr A started feeling that there is some supernatural power in his room and became extremely fearful and pleaded for constant company of family members. Following day started having irrelevant talk, muttering, aggression and suspiciousness and had a firm belief that some supernatural force is going to harm him. He was brought to our Psychiatry OPD by parents and was admitted as there was a risk of harm to others or self. In the ward patient became extremely aggressive and ran out and smashed random bikes.
Apart from the neurological damage it can cause, chloroquine can also prove toxic to other organs in your body such as your heart, eyes, and ears.
Chloroquine by itself is cardiotoxic and can potentially lead to life threatening cardiac arrhythmia causing death. The proposed treatment regimen for COVID-19 calls for chloroquine to be used in conjunction with azithromycin, which also carries with it the very same risk making it more dangerous.
A small study in France enrolling 26 treated patients and 16 non-randomized controls showed that hydroxychloroquine alone or in combination with azithromycin shortened the time to resolution of viral shedding of COVID-19.1
Based on this study, clinicians in many countries have begun using these medications in clinical practice, and multiple randomized trials are being initiated. However, chloroquine, hydroxychloroquine and azithromycin all prolong QT interval, raising concerns about the risk of arrhythmic death from individual or concurrent use of these medications.
There would seem to be a consensus amongst the scientific community that a great deal more research remains to be needed.
Balanced against the clear life-saving benefits of giving effective antimalarials promptly in malaria, with the exception of halofantrine, concerns over cardiotoxicity have not limited the current use of the quinoline and structurally related antimalarial drugs.
The importance of robust detection and evaluation of extremely rare and serious adverse events such as sudden unexplained death in real-world populations and the implications of such findings for population-based drug administration strategies underscore the need for ongoing synthesis of all available clinical evidence.
According to some, the risk of eye damage is perhaps on of the biggest risks. Chloroquine can cause retinopathy, permanent damage to the retina, as well as damage to the cornea and/or lens which would have a detrimental effect on vision. “Even when the clinician and patient adhere to screening guidelines and retinopathy is detected in a sub-clinical stage, discontinuation of chloroquine or hydroxychloroquine therapy may not stop the progression of retinopathy to a stage where the patient loses vision.”
Chloroquine (CQ) is used to prevent and treat malaria and amebiasis, while hydroxychloroquine (HCQ), a less toxic metabolite of chloroquine, is used to treat rheumatic diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) and Sjogren’s syndrome. Both medications can cause corneal deposits, posterior subcapsular lens opacity, ciliary body dysfunction, and most important, irregularity in the macular pigmentation in the early phase, a ring of macular pigment dropout in the advanced stage, and peripheral bone spicule formation, vascular attenuation, and optic disc pallor in the end-stage. Ocular symptoms of retinopathy include blurred and partial loss of central vision, side vision and in the later stage, night vision. Symptoms of corneal deposits include haloes and glare.
Although there isn’t as much risk of hearing damage as there is vision damage, it is still a distinct possibilty.
Hydroxychloroquine (Plaquenil®) is an antimalarial agent which is approved for rheumatoid arthritis, systemic lupus erythematosis, discoid lupus erythematosis, prophylaxis and treatment of acute malaria, and photodermatosis . In the Netherlands it has been approved since 1966.
Hydroxychloroquine is chemically closely related to chloroquine (Nivaquine®). Hearing loss or ototoxicity are not mentioned in the SPC of hydroxychloroquine . The SPC of chloroquine states both hearing loss and deafness as possible ADRs.
Until May 31, 2005 Lareb received three reports of hearing loss associated with the use of hydroxychloroquine. No cases have been reported in association with the use of chloroquine. Report A concerns a female aged 69, who experienced hearing loss (especially low tones) and tinnitus several months after starting hydroxychloroquine for indication lupus erythematosis. The hearing loss was confirmed with an audiologic examination. Five years after discontinuation of the hydroxychloroquine, functioning of her right ear is still impaired.
Case B was reported by the MAH and concerns a female aged 57, who experienced deafness and tinnitus 4 years after starting hydroxychloroquine. Hydroxychloroquine was withdrawn and one year later the patient had not recovered.
Recently we received a third report of hearing loss (C). It concerns a female aged 51, who experienced hearing loss 7 months after starting hydroxychloroquine for the indication scleroderma. An audiogram showed a bilateral perception hearing reduction of 30 to 50 dB for high frequencies. The hydroxychloroquine has been withdrawn, 2.5 months later patient has not recovered.
Experts from Johns Hopkins Medicine have published a number of guides online including their antibiotics guide, Johns Hopkins ABX. These experts, from the one of the most respected medical institutions in the US, routinely update the guides to provide the most up to date information.
Regarding the proposed use of chloroquine in the treatment of COVID-19, the guide stated that there was “minimal, low quality evidence” to support it. In addition to this it states:
Retinopathy is one of the most serious adverse events associated with hydroxychloroquine and it is NOT reversible. The American Academy of Ophthalmology recommends screening for hydroxychloroquine-related retinopathy: examination prior to therapy initiation to rule out preexisting maculopathy and annual screening after 5 years for patients on acceptable doses and without major risk factors
Hydroxychloroquine has been used in a recent COVID-19 outbreak. Limited available data are largely based on in vitro studies and clinical series and one small RCT showing no effect.
In a small, observational, non-randomized study of (n=36) patients with SARS-CoV-2 infection, administration of hydroxychloroquine 200 mg q8h for 10 days (n=20) resulted in higher clearance of virus (70%) on day 6 compared to controls (12.5%). Six patients also received azithromycin, and authors argued in a post-hoc analysis that addition of azithromycin resulted in even higher, but statistically nonsignificant clearance. This study, however, has many limitations including small sample size, exclusions from analysis of patients who were lost to follow-up (e.g. escalation of care, death), no clinical outcomes were reported or colation of viral clearance and clinical outcomes has been made.
A pilot RCT of 30 patients comparing HCQ v. placebo found that on day 7, COVID-19 nucleic acid of throat swabs was negative in 13 (86.7%) cases in the HCQ group and 14 (93.3%) cases in the control group (P>0.05). There was no significant clinical difference between the groups. The study suggests that if HCQ has an effect it is at most modest, so larger studies need to be performed.
Larger and properly designed studies are needed to determine the benefits of hydroxychloroquine in the treatment of COVID-19-positive patients and the role of combination therapy (e.g. with azithromycin).
Dr. Remington Nevin is an epidemiologist and an expert on anti-malarial drugs. He is also the founder and a director of the Quinism Foundation, a nonprofit organization dedicated to promoting and supporting education and research on quinism, the family of medical disorders caused by poisoning by mefloquine, tafenoquine, chloroquine, and related quinoline drugs. They have been quite vocal in their opposition to the notion of using chloroquine as a treatment for COVID-19.
For more information you can visit the Quinism Foundation website at:
There are a number of other possible treatments, much less toxic treatments, that are also being looked at. For example studies have shown ivermectin, an antiparasitic, might also be effective at treating COVID-19 so it is important to remember that hydroxychloroquine isn’t the only drug that could work. Under no circumstances should you take medication that has not been prescribed for you by your doctor.
Listen to what the medical community says
I formed my opinions after doing a great deal of research and all I would suggest to you is that you do some of your own before you come to any conclusions. This should be the case any time you are considering a matter that might have life or death consequences. Where you get your information is equally important when it comes to decision making, so I am more likely to rely on academic research and journal articles as primary sources rather than public figures like the President of the United States.
Right now most of the major scientific and medical journals are offering free access to any articles relating to COVID-19, and Google Scholar has links to all of them. It is a good way to keep up to date with the latest research as it becomes available.
With hydroxychloroquine being hailed by some as a “game changer” in the fight against COVID-19, Marj and Trina are taking a closer look at the subject in a three part series. In part three our hosts engage an international panel that includes Dr. Jane Quinn, associate professor at Charles Stuart University in Australia, and ADF veteran Maj.(ret.) Stuart McCarthy as well as veterans Dave Rimmington from the United Kingdom and Dave Bona from Canada.
With hydroxychloroquine being hailed by some as a “game changer” in the fight against COVID-19, Marj and Trina are taking a closer look at the subject in a three part series. In part two Canadian veteran Sgt.(ret.) Mike Rude joins Marj and Trina to discuss his perspective.
With hydroxychloroquine being hailed by some as a “game changer” in the fight against COVID-19, Marj and Trina are taking a closer look at the subject in a three part series. In part one they talk with Dr. Remingtion Nevin, epidemiologist and specialist in anti-malarial drugs who is also the founder of the Quinism Foundation for his take.
Although there isn’t a cure for quinism right now there are things you can do to improve your quality of life. In this episode, Dr. Keith shares with you some of the effective treatment options that are available.