salt. We have to realize that this data may be telling us something that isn’t true. That isn’t a medical reality. But that’s not a reason to act. The key is going to be something called biological plausibil-


ity—whether or not an agent behaves in a way that we can un- derstand based on what we already know about it. In large, gold standard randomized, controlled trials, the data often stood for itself. When we’re looking at much smaller studies in data that’s


not collected in as rigorous a way, and we have to ask ourselves, does this data make sense? One current example of this is chloroquine. The data is very


limited on this drug and whether it can treat COVID-19. It’s based on small number of patients. It has not peer reviewed. It has not been randomized. In the old days we would have said ‘Well, come back later when you’ve conducted a rigorous study.’ Now we have to take what we have and look at the biological plausi- bility. Is it possible it could treat this infection? We have good cell culture data that the drug might have some impact based on how we know about how the virus infects cells and how it acts in the body. So we have to act on that. Right now, available evidence is worth more than best evi- dence, because we can only use what’s available.


WebMD: What about the flood of preprints that are being pub- lished to open access sites like MedRxiv. There are some scientists who have shared new information via Twitter. Wilson: I think it is inspiring to see all the work that’s being


done on this right now. It feels like trying to go to the moon, this scramble for information. There are so many researchers and scientists who are working very, very hard to turn the tide, and I find a lot of optimism and hope in that. It won’t all turn out to be true, but I think it’s amazing to see the effort.


aRE WaRNINGS aGaINST NSaIDS IN COVID-19 WaRRaNTED?


A warning from French health officials suggests that grave


adverse events have been reported with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, in people with COVID-19, and they recommend treatment instead with acetaminophen. But many doctors, particularly outside of France, reacted on


social networks saying there isn’t enough evidence for such a recommendation. The Spanish Ministry of Health stated in mid-March that


there is no evidence that ibuprofen (or other NSAIDs) makes COVID-19 infection worse.


British doctors broadly agreed, although they say acet- aminophen is a better choice for infection in general.


One U.S. expert says evidence of risks to people with CO-


VID-19 beyond those already well-known with infections in general and NSAIDs hasn’t been established.


On March 14, the French government reported "serious


adverse events" linked to NSAIDs in people with COVID-19. Soon after, French Health Minister Olivier Véran tweeted that "taking anti-inflammatory drugs (ibuprofen, cortisone...) could


be an aggravating factor of the [COVID-19] infection." "If you have a fever, take paracetamol," Veran tweeted. "If


you are already on anti-inflammatory drugs or in doubt, ask your doctor for advice." (Paracetamol is a generic term for acetamin- ophen commonly used outside the United States.)


In a statement on its website, Reckitt Benckiser, maker of the


Nurofen brand of ibuprofen, said: "Appropriate use of ibuprofen and paracetamol is still currently being recommended by most European health authorities as part of the symptomatic treatment of COVID-19. Reckitt Benckiser is not aware of any evidence that ibuprofen adversely impacts the outcome in patients suffer- ing from COVID-19 infection." The company "has neither received new safety information


nor been involved in the evaluation of any adverse events regard- ing the use of ibuprofen in COVID-19," it adds. "As with any medicine, we would remind consumers and their caregivers to carefully read and follow the instructions provided on the pack- aging and in the patient information leaflet."


No Evidence of any Unique Risk of NSaIDs in COVID-19 Gregory Poland, MD, a professor of medicine and infectious


disease and director of the Vaccine Research Group at the Mayo Clinic in Rochester, MN, said that without clarification of any new data detailing effects, additional risks of NSAIDs related to COVID-19 are questionable. Poland told Medscape Medical News: "I think there is far


inadequate information to make a blanket statement like that [which the French Health Minister has made]." NSAIDs, often recommended to relieve fever and symptoms


causes any STRUCTURE to break down Pain


Numbness/Tingling Dizziness Arthritis Headaches


The body’s foundation is the head and


starts to break down.


Logical. Simple.


Effective.


Triad Upper Cervical Clinic 432A W. Mountain St.,


Kernersville


336.992.2536 www.TriadUpperCervical.com M. Chad McIntyre, D.C. offers Orientation Classes at his office once per month


APRIL 2020 13


upper cervical spine. When it shifts out of balance, the body


Ignoring the FOUNDATION


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