Hydroxychloroquine...........

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Dad
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In reply to [removed post] • 7:14p, 7/29/20
AG
JJMt said:
Zobel said:
Why are those elements critical? How do you know?
I don't know. But that has been the hypothesis for months. And, as we've and other doctors have posted here over and over again, there are studies that support that hypothesis.

You guys keep stating that that hypothesis is wrong, and that us dumb non-doctors and non-scientists ought to go away. But then you keep citing studies that don't even address the hypothesis. You either think we're too stupid to notice or you're hiding behind procedures that will take so long to follow that they're worthless.

If the hypothesis is wrong, show me the studies. Otherwise, you don't know if it's wrong or not.

I don't know if it works or not and I'm not sure if I will take it if I get Covid, but it's pretty clear to me several studies were designed to get a bad result. Give it to someone in the late stages of the virus instead close to the first symptoms. Give it to a sicker group compared to the control group. Give people a toxic dose level of HCQ. Imagine if someone did a pain study with Tylenol and gave patients 30 grams per day of it. You might get some negative results.
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Red Fishing Ag93
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In reply to Mantis Toboggan MD • 7:22p, 7/29/20
AG
Thank you for finding and posting that.

It will be interesting to follow.
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Mantis Toboggan MD
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In reply to revvie • 7:32p, 7/29/20
AG
revvie said:
Can someone whose a medical professional summarize all the previous data
That is a complicated question. From my perspective, the biggest take home point is that any data at this point is not high quality and not sufficient either way, it is simply too early to and we are lacking sufficient quality evidence to say much about anything in how we manage COVID. In my opinion, anyone who is staunchly in favor of one thing or the other, has an agenda. Providers should continuously being interpreting and integrating high quality evidenced-based medicine into how they practice. Furthermore, how they practice should be done in a shared decision-making process with their patients weighing the risks and benefits.

My personal take, as someone who is primarily clinical and in the ICU, hydroxychloroquine, zinc, nor any antibiotic are not effective for the patients that reach me. Supportive treatment is the number one therapy. Anecdotally, I have had positive results with convalescent plasma, but likely because it has become widely available where I practice so who knows if it is a causative effect. More or less I have had equivocal to somewhat positive outcomes with tociluzmab (anti-inflammatory monoclonal antibody), and Remdesivir. But whether they are efficacious or not is complicated by a myriad of uncontrolled factors, notably timing of administration, severity of disease, and pre-existing comorbidites. Because of all of this, I don't go around touting any of these therapies as a "cure", because in my experience I don't have evidence to suggest any are, despite having positive (and negative) outcomes.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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94chem
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In reply to Zobel • 7:32p, 7/29/20
Zobel said:
But you see how ridiculous that is, right? What's to stop the next guy in line from saying zinc AND tigers blood? AND waning moon?

There is a proposed method of action for the HCQ and zinc part - it's supposed to act as zinc ionophore. Docs say people who aren't malnourished have plenty of ambient zinc, and the hard part is not getting enough zinc but getting it into the cell. If I'm not mistaken in the in vitro experiment the effect persists with varying levels of ambient zinc. So... I guess the question is why is additional zinc needed? I suspect the answer is: it isn't, and this is just another example of a plausible method of action that works in vitro but fails in practice. It's not the first and won't be the last.


And yet there's a guy with 2 Nobel prizes who insisted on pumping everyone full of vitamin C. Yeah, he was wrong, but so what? It's not like we actually know how much of every vitamin or mineral everyone needs. The US RDA is just a piece of paper. So is the food pyramid.
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Marcus Aurelius
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7:34p, 7/29/20
AG
Wow. This thread. Never would have thought it would have lasted this long. I think a meta-analysis of all the RCTs needs to be performed and I suspect someone is doing this. I am still in the pro HCQ camp after sifting thru all this data. I wish the Henry Ford study group was more careful with their randomization. All this stuff is so hard to digest. For example - the negative toci trial posted today. Yet - with my own eyes - I have seen it turn the sickest around.
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Fenrir
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In reply to Dr. Not Yet Dr. Ag • 7:46p, 7/29/20
Dr. Not Yet Dr. Ag said:
chap said:
I know I already said this, but I'll say it again. I would encourage y'all to read Dr. Reveille's post from last night. He talks about all 65 studies that have been published so far. 39 have been positive, 10 have been inconclusive, and the others negative and for some reason people just keep talking about the negative ones. He specifically called out the fake data used in the NEJM study that people keep referencing.
I have not referenced the withdrawn NEJM data. The NEJM PEP study is a completely different study. As for his post, unfortunately some physicians are far enough removed from academic medicine to not remember the hierarchy of medical literature, and what constitutes high quality evidence. Not all studies are created equal. Below is a table of how we typically classify level of evidence in medicine. Level C evidence generally leads to weak recommendations, and is usually ignored for physician preference. Level A evidence essentially sets standard of care. What has been posted by myself and others definitively demonstrates level A evidence for lack of efficacy for HCQ for COVID. If you ignored all the negative RCT data, what you would be left with is level C evidence.

Efficacy can only be determined through randomized controlled trials or very well controlled, large patient population prospective cohort studies with a large effect size, anything short of that is low quality evidence and cannot definitively determine efficacy. The reason you keep seeing us only posting negative studies, is because we are only posting high quality evidence, and unfortunately of the available high quality evidence, every single study is negative.

If you actually read those positive observational studies, you will see that all of them call for randomized control trials to determine efficacy (outside of Raoult's)...well those RCTs are being posted for you to peruse.



Is there any therapy for CV19 that is supported by that level of study?
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Dr. Not Yet Dr. Ag
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In reply to Fenrir • 8:03p, 7/29/20
Fenrir said:
Dr. Not Yet Dr. Ag said:
chap said:
I know I already said this, but I'll say it again. I would encourage y'all to read Dr. Reveille's post from last night. He talks about all 65 studies that have been published so far. 39 have been positive, 10 have been inconclusive, and the others negative and for some reason people just keep talking about the negative ones. He specifically called out the fake data used in the NEJM study that people keep referencing.
I have not referenced the withdrawn NEJM data. The NEJM PEP study is a completely different study. As for his post, unfortunately some physicians are far enough removed from academic medicine to not remember the hierarchy of medical literature, and what constitutes high quality evidence. Not all studies are created equal. Below is a table of how we typically classify level of evidence in medicine. Level C evidence generally leads to weak recommendations, and is usually ignored for physician preference. Level A evidence essentially sets standard of care. What has been posted by myself and others definitively demonstrates level A evidence for lack of efficacy for HCQ for COVID. If you ignored all the negative RCT data, what you would be left with is level C evidence.

Efficacy can only be determined through randomized controlled trials or very well controlled, large patient population prospective cohort studies with a large effect size, anything short of that is low quality evidence and cannot definitively determine efficacy. The reason you keep seeing us only posting negative studies, is because we are only posting high quality evidence, and unfortunately of the available high quality evidence, every single study is negative.

If you actually read those positive observational studies, you will see that all of them call for randomized control trials to determine efficacy (outside of Raoult's)...well those RCTs are being posted for you to peruse.



Is there any therapy for CV19 that is supported by that level of study?

Dexamethasone and Remdesivir are the only ones. Although Remdesivir effect size was pretty weak.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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GE
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11:56p, 7/29/20
AG
Anecdote but had a friend tell me today that he asked his dr. F
for HCQ and the doctor basically said the FDA wouldn't permit it. He ended up staying in hospital on oxygen for a couple days.
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Picadillo
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4:00a, 7/30/20
https://pbs.twimg.com/media/EeIsYd4XsAEqN_z?format=jpg&name=medium
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DadHammer
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In reply to GE • 6:06a, 7/30/20
AG
Now that is horrible.
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Red Fishing Ag93
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In reply to Picadillo • 7:31a, 7/30/20
AG
Absolutely crazy stuff.
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Ranger222
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In reply to Keegan99 • 7:50a, 7/30/20
AG
Keegan99 said:

Quote:
'These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19.'

This is a test of the wrong hypothesis.

Literally posted on the previous page......


Quote:
We conducted an open-label, cluster-randomized trial including asymptomatic contacts exposed to a PCR-positive Covid-19 case in Catalonia, Spain. Clusters were randomized to receive no specific therapy (control arm) or HCQ 800mg once, followed by 400mg daily for 6 days (intervention arm). The primary outcome was PCR-confirmed symptomatic Covid-19 within 14 days. The secondary outcome was SARS CoV-2 infection, either symptomatically compatible or a PCR-positive result regardless of symptoms. Adverse events (AEs) were assessed up to 28 days.

The analysis included 2,314 healthy contacts of 672 Covid-19 index cases identified between Mar 17 and Apr 28, 2020. A total of 1,198 were randomly allocated to usual care and 1,116 to HCQ therapy. There was no significant difference in the primary outcome of PCR-confirmed, symptomatic Covid-19 disease (6.2% usual care vs. 5.7% HCQ; risk ratio 0.89 [95% confidence interval 0.54-1.46]), nor evidence of beneficial effects on prevention of SARS-CoV-2 transmission (17.8% usual care vs. 18.7% HCQ). The incidence of AEs was higher in the intervention arm than in the control arm (5.9% usual care vs 51.6% HCQ), but no treatment-related serious AEs were reported.

Post-exposure therapy with HCQ did not prevent SARS-CoV-2 disease and infection in healthy individuals exposed to a PCR-positive case. Our findings do not support HCQ as pos-texposure prophylaxis for Covid-19.

https://www.medrxiv.org/content/10.1101/2020.07.20.20157651v1.full.pdf+html

Quote:
COVID-19 has rapidly become a pandemic for which no antiviral drug or vaccine is yet available24. Several clinical studies are ongoing to evaluate the efficacy of repurposed drugs that have demonstrated antiviral efficacy in vitro. Among these candidates, hydroxychloroquine (HCQ) has been given to thousands of individuals worldwide but definitive evidence for HCQ efficacy in treatment of COVID-19 is still missing6,7,17,18. We evaluated the antiviral activity of HCQ both in vitro and in SARS-CoV-2-infected macaques. HCQ showed antiviral activity in African green monkey kidney cells (VeroE6) but not in a model of reconstituted human airway epithelium. In macaques, we tested different treatment strategies in comparison to placebo, before and after peak viral load, alone or in combination with azithromycin (AZTH). Neither HCQ nor HCQ+AZTH showed a significant effect on the viral load levels in any of the tested compartments. When the drug was used as a pre-exposure prophylaxis (PrEP), HCQ did not confer protection against acquisition of infection. Our findings do not support the use of HCQ, either alone or in combination with AZTH, as an antiviral treatment for COVID-19 in humans.

https://www.nature.com/articles/s41586-020-2558-4
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Teslag
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9:32a, 7/30/20
AG
My husband currently deployed with medical service and logistics for the Middle East. He sent me pics of HCQ and zinc on the Army shelves next to the covid tests. They get sent out to units together.
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GE
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In reply to Teslag • 9:49a, 7/30/20
AG
Leather Tuscadero said:
My husband currently deployed with medical service and logistics for the Middle East. He sent me pics of HCQ and zinc on the Army shelves next to the covid tests. They get sent out to units together.
You can upload photos directly from your phone
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NewOldAg
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In reply to Ranger222 • 10:04a, 7/30/20
AG
If I read that right, HCQ was proven not to act as a vaccine that stops people from getting sick.

But that finding doesn't tell me whether or not it is effective in saving someone's life once they have it. If HCQ is proven to save someone's life, shouldn't we be using that?
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Teslag
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In reply to GE • 10:35a, 7/30/20
AG
GE said:
Leather Tuscadero said:
My husband currently deployed with medical service and logistics for the Middle East. He sent me pics of HCQ and zinc on the Army shelves next to the covid tests. They get sent out to units together.
You can upload photos directly from your phone


Not without stars.
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In reply to NewOldAg • 10:37a, 7/30/20
Infection_Ag11
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In reply to Fenrir • 10:40a, 7/30/20
AG
Fenrir said:
Dr. Not Yet Dr. Ag said:
chap said:
I know I already said this, but I'll say it again. I would encourage y'all to read Dr. Reveille's post from last night. He talks about all 65 studies that have been published so far. 39 have been positive, 10 have been inconclusive, and the others negative and for some reason people just keep talking about the negative ones. He specifically called out the fake data used in the NEJM study that people keep referencing.
I have not referenced the withdrawn NEJM data. The NEJM PEP study is a completely different study. As for his post, unfortunately some physicians are far enough removed from academic medicine to not remember the hierarchy of medical literature, and what constitutes high quality evidence. Not all studies are created equal. Below is a table of how we typically classify level of evidence in medicine. Level C evidence generally leads to weak recommendations, and is usually ignored for physician preference. Level A evidence essentially sets standard of care. What has been posted by myself and others definitively demonstrates level A evidence for lack of efficacy for HCQ for COVID. If you ignored all the negative RCT data, what you would be left with is level C evidence.

Efficacy can only be determined through randomized controlled trials or very well controlled, large patient population prospective cohort studies with a large effect size, anything short of that is low quality evidence and cannot definitively determine efficacy. The reason you keep seeing us only posting negative studies, is because we are only posting high quality evidence, and unfortunately of the available high quality evidence, every single study is negative.

If you actually read those positive observational studies, you will see that all of them call for randomized control trials to determine efficacy (outside of Raoult's)...well those RCTs are being posted for you to peruse.



Is there any therapy for CV19 that is supported by that level of study?


Dex and remdesivir but only the Dex study really moves the needle. The remdesivir study was ultimately meh.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Picadillo
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11:17a, 7/30/20
People are dying. Do we have time to attain the highest level of clinical efficacy or do we go with what works.
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In reply to Picadillo • 12:01p, 7/30/20
Bruce Almighty
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12:36p, 7/30/20
AG
My wife took care of a family medicine doctor that prescribed himself HCQ. Has been taking it for a while, became symptomatic, tested positive, and then took a turn for the worse and is in the ICU. She's of the opinion that HCQ is voodoo medicine and doesn't work and any success stories are impossible to validate with a disease that has more than a 99% recovery rate.
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PJYoung
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In reply to Ranger222 • 12:37p, 7/30/20
AG
Ranger222 said:
Keegan99 said:

Quote:
'These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19.'

This is a test of the wrong hypothesis.

Literally posted on the previous page......


Quote:
We conducted an open-label, cluster-randomized trial including asymptomatic contacts exposed to a PCR-positive Covid-19 case in Catalonia, Spain. Clusters were randomized to receive no specific therapy (control arm) or HCQ 800mg once, followed by 400mg daily for 6 days (intervention arm). The primary outcome was PCR-confirmed symptomatic Covid-19 within 14 days. The secondary outcome was SARS CoV-2 infection, either symptomatically compatible or a PCR-positive result regardless of symptoms. Adverse events (AEs) were assessed up to 28 days.

The analysis included 2,314 healthy contacts of 672 Covid-19 index cases identified between Mar 17 and Apr 28, 2020. A total of 1,198 were randomly allocated to usual care and 1,116 to HCQ therapy. There was no significant difference in the primary outcome of PCR-confirmed, symptomatic Covid-19 disease (6.2% usual care vs. 5.7% HCQ; risk ratio 0.89 [95% confidence interval 0.54-1.46]), nor evidence of beneficial effects on prevention of SARS-CoV-2 transmission (17.8% usual care vs. 18.7% HCQ). The incidence of AEs was higher in the intervention arm than in the control arm (5.9% usual care vs 51.6% HCQ), but no treatment-related serious AEs were reported.

Post-exposure therapy with HCQ did not prevent SARS-CoV-2 disease and infection in healthy individuals exposed to a PCR-positive case. Our findings do not support HCQ as pos-texposure prophylaxis for Covid-19.

https://www.medrxiv.org/content/10.1101/2020.07.20.20157651v1.full.pdf+html

Quote:
COVID-19 has rapidly become a pandemic for which no antiviral drug or vaccine is yet available24. Several clinical studies are ongoing to evaluate the efficacy of repurposed drugs that have demonstrated antiviral efficacy in vitro. Among these candidates, hydroxychloroquine (HCQ) has been given to thousands of individuals worldwide but definitive evidence for HCQ efficacy in treatment of COVID-19 is still missing6,7,17,18. We evaluated the antiviral activity of HCQ both in vitro and in SARS-CoV-2-infected macaques. HCQ showed antiviral activity in African green monkey kidney cells (VeroE6) but not in a model of reconstituted human airway epithelium. In macaques, we tested different treatment strategies in comparison to placebo, before and after peak viral load, alone or in combination with azithromycin (AZTH). Neither HCQ nor HCQ+AZTH showed a significant effect on the viral load levels in any of the tested compartments. When the drug was used as a pre-exposure prophylaxis (PrEP), HCQ did not confer protection against acquisition of infection. Our findings do not support the use of HCQ, either alone or in combination with AZTH, as an antiviral treatment for COVID-19 in humans.

https://www.nature.com/articles/s41586-020-2558-4

It is amazing that soooooo many people would rather believe that there is some kind of conspiracy against Trump that prevents HCQ or HCQ+AZTH to be administered for Covid-19. The FB videos keep popping up and getting millions of views in a few hours.

Conspiracy theories are good business I guess.
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Red Fishing Ag93
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12:48p, 7/30/20
AG
People go crazy over money and power. I'm not in on the majority of conspiracies. There are plenty out there but the word today is reserved for the least likely of them to have any truth at all, and never used for actual conspiracies.

I consider myself cautious on what the government gives us.

Like one of my favorite Presidents ever said....and I quote.

"The nine most terrifying words in the English language are: I'm from the Government, and I'm here to help. "
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ETFan
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1:16p, 7/30/20
The forum 16 threads on this can't possibly be real?


Has this been posted?
https://www.acpjournals.org/doi/10.7326/M20-4207
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dragmagpuff
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In reply to ETFan • 1:26p, 7/30/20
AG
ETFan said:
The forum 16 threads on this can't possibly be real?


Has this been posted?
https://www.acpjournals.org/doi/10.7326/M20-4207
Key Points:
Quote:
Randomized, double-blind, placebo-controlled trial conducted from 22 March through 20 May 2020. (ClinicalTrials.gov: NCT04308668)
Quote:
Participants:
Symptomatic, nonhospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 and high-risk exposure within 4 days of symptom onset.

Intervention:
Oral hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 more days) or masked placebo.

Measures:
Symptoms and severity at baseline and then at days 3, 5, 10, and 14 using a 10-point visual analogue scale. The primary end point was change in overall symptom severity over 14 days.
Quote:
Conclusion:

Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19.

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Zobel
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In reply to ETFan • 1:27p, 7/30/20
AG
But they didn't use zinc.

But they didn't use Azithromycin.

But they didn't take medicine when Mars was in retrograde.

Also should note the paper which more or less started this discussion (Raoult) didn't include zinc, either, but supposedly cured people.
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ETFan
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In reply to dragmagpuff • 1:42p, 7/30/20
Thanks for summarizing that for me.
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chap
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In reply to dragmagpuff • 1:42p, 7/30/20
AG
More key points:

Quote:
Patients in this study are relatively young and most of them recover without assistance. This reduces the room for a treatment to make improvements. The maximum improvement of an effective treatment would be expected before all patients approach recovery, as shown in the figure below. Authors focus on the end result where most have recovered, but it is more informative to examine the curve and the point of maximum effectiveness. Authors did not collect data for every day but they do have interim results for days 3, 5, 10. The results are consistent with an effective treatment and show a statistically significant improvement, p = 0.05, at day 10 (other unreported days might show increased effectiveness).
Quote:
Results also show a larger treatment effect for those >50, not statistically significant due to the small sample, but noted as COVID-19 risk dramatically increases with age. The effect may be more visible here because younger patients may on average have more mild cases with less room for improvement. In general patients in this study have relatively mild symptoms on average, limiting the chance to observe improvement.
Quote:
The study relies on Internet surveys. Known fake surveys were submitted to the similar PEP trial and there could be an unknown number of undetected fake surveys in both trials. The study shows a high incidence of side effects in the placebo arm, which could be in part due to fake entries
Quote:
In summary, we believe the results of this study are positive for HCQ being an effective treatment, however we have classified this study as inconclusive for now pending feedback and further analysis.

https://c19study.com/
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2PacShakur
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In reply to Zobel • 2:30p, 7/30/20
AG
Zobel said:
But they didn't use zinc.

But they didn't use Azithromycin.

But they didn't take medicine when Mars was in retrograde.

Also should note the paper which more or less started this discussion (Raoult) didn't include zinc, either, but supposedly cured people.
Everyone knows postprandial administration is the best administration.
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goodAg80
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In reply to 2PacShakur • 3:00p, 7/30/20
AG
2PacShakur said:
Zobel said:
But they didn't use zinc.

But they didn't use Azithromycin.

But they didn't take medicine when Mars was in retrograde.

Also should note the paper which more or less started this discussion (Raoult) didn't include zinc, either, but supposedly cured people.
Everyone knows postprandial administration is the best administration.
I thought post-coital administration was the best administration.
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Dad
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5:30p, 7/30/20
AG
Has anyone seen posts from a guy named Brian Charles Procter on facebook. I am posting his name because he is holding himself out as a public figure with his HCQ take.

He has a picture up of a board that claims he has treated 161 test confirmed positive Covid cases and another 100 plus that he claims are Covid but didn't test positive and only one ended up in the hospital.

If he is telling the truth and this patient population is representative of the general population in age would it be statistically significant to have only 1 out of 161 ending up in the hospital?
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Dr. Not Yet Dr. Ag
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In reply to Dad • 5:40p, 7/30/20
Dad said:
Has anyone seen posts from a guy named Brian Charles Procter on facebook. I am posting his name because he is holding himself out as a public figure with his HCQ take.

He has a picture up of a board that claims he has treated 161 test confirmed positive Covid cases and another 100 plus that he claims are Covid but didn't test positive and only one ended up in the hospital.

If he is telling the truth and this patient population is representative of the general population in age would it be statistically significant to have only 1 out of 161 ending up in the hospital?

This is the problem with anecdotes, we have no way to verify claims. Speaking as an ER physician who admits patients to the hospital as part of my job, I am almost never contacting the primary care physician regarding their patient's admission. The reality is that most PCPs have no clue when their patients are admitted to the hospital, unless they also practice inpatient medicine, which is uncommon nowadays.

Regardless, treating patients in an outpatient setting is pre-selecting for individuals that are healthy enough to not require hospitalization at the moment, and this is a disease where the large majority will never require hospitalization.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Dad
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In reply to Dr. Not Yet Dr. Ag • 6:07p, 7/30/20
AG
Dr. Not Yet Dr. Ag said:
Dad said:
Has anyone seen posts from a guy named Brian Charles Procter on facebook. I am posting his name because he is holding himself out as a public figure with his HCQ take.

He has a picture up of a board that claims he has treated 161 test confirmed positive Covid cases and another 100 plus that he claims are Covid but didn't test positive and only one ended up in the hospital.

If he is telling the truth and this patient population is representative of the general population in age would it be statistically significant to have only 1 out of 161 ending up in the hospital?

This is the problem with anecdotes, we have no way to verify claims. Speaking as an ER physician who admits patients to the hospital as part of my job, I am almost never contacting the primary care physician regarding their patient's admission. The reality is that most PCPs have no clue when their patients are admitted to the hospital, unless they also practice inpatient medicine, which is uncommon nowadays.

Regardless, treating patients in an outpatient setting is pre-selecting for individuals that are healthy enough to not require hospitalization at the moment, and this is a disease where the large majority will never require hospitalization.

I could see why you wouldn't need to contact the primary care doc, but if he really cared about authentic data his office could easily follow up with every patient until they fully recovered.

I guess there are too many assumptions that have to happen for his board information to mean anything.
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oldyella
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7:59p, 7/30/20
AG
Anyone have an idea where to procure HCQ and Zinc to keep on hand, edit: A doctor that is willing to prescribe it or offshore? I am a believer if taken at the earliest onset of a symptom. I took it two decades ago when I was overseas with no negative effects.

Edit 2: If I know HCQ is safe for me on past experience and there is a statistical mound of anecdotal evidence it works, otherwise it is no worse than pissing vitamins away and I am STILL in the same boat of experiencing existing treatments. Best case it makes a difference, like tamiflu does for the flu. Those of you who take vitamins and believe this is a poison pill, you need to rethink your vitamin expense.
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In reply to Dr. Not Yet Dr. Ag • 5:55a, 7/31/20
 
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