Vitamin C and COVID Research Update

You're live. Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul. And today on the program, as, as advertised, if you saw it, we're going to talk about what the updates are in regard to COVID and vitamin C. And this is a little bit coming full circle from some things that we did almost a year ago now. And then a couple updates in between. And so you might say, well, why, you know, why is there a reason to update? Is there a reason to update? What's going on? Well, in the intervening time since about a year ago when the, at least in the US, we started to have some close downs and people started to shelter in place, etc. A lot has happened. It's been just about 12 months at this point. So if you're listening live, it's March 11th, 2021. If you're listening in the future, it is whatever time it is for you. And if you're listening, you know, a long time in the future, this, this may all seem a little out of context. But what's happened in the meantime, and I think it's important just to kind of give a little bit of structure around it, is the idea that one of the things certainly not the only thing, certainly not, you know, a cure, certainly not, you know, all of those things. But one of the many things that was proposed and tried early on in Asia when the coronavirus, the COVID-19 as we kind of call it now, SARS-CoV-2, was reaching epidemic and then pandemic levels, was to use a relatively inexpensive medical therapy being vitamin C. And so early on, there was a series of case reports from China that I had reported on here and then on a number of other national and international type podcasts and a couple of courses. And I reported on the cases as they were coming out of the hospitals in China. And so what they were seeing in China was that if they had patients who were hospitalized and they were using intravenous vitamin C with the hospitalized patients, with all of the other normal medications for people who are in critical care or ICU, that people who got the intravenous vitamin C often had a higher propensity for survival. And they also were in the hospital for a shorter amount of time. Now, those are 2 pretty good outcome markers if you get to the hospital with anything, not being there as long and having a higher propensity for survival. Those are 2 really good things. Well, the other thing that was going on at the same time that I think we had an entire program on, and I know I did a number of courses about it, was When it comes to preventing people from going to the hospital, and again, we're going back a year ago and we're talking about China. One of the things that they did was to import into the area a lot of vitamin C in a bulk form as ascorbic acid. And they were giving that to people who weren't in the hospital as a way to increase their vitamin C levels, which of course you can do by taking it. Orally. And the theory was, if you don't need to be in the hospital, then we're not going to go and give you intravenous vitamin C. We're going to give you oral vitamin C as a way to help, you know, give you at least one factor that might be predictive of you staying out of the hospital. Because one of the things, if you go back and you read the original reports from the hospitals, there was just like in many, many other places around the world, their hospital system became overwhelmed. So anything you do to keep people out of the hospital was very, very useful. Now, the thing that happens whenever you start to report these sort of things in medicine especially is people, rightly so, will say, well, you know, that's a case or a series of cases is a really good start for information because it gives us a potential theory, gives us a place to start from as far as what we might want to investigate. Gives us a place to begin when it comes to what would the mechanisms behind vitamin C helping these people be, if indeed there are mechanisms and it is helping and all of that. So there's a lot of things that, for example, a case series can be helpful with. So that was— that's good. That's the upside. The downside, and you've heard me speak about this if you've been sort of, you know, following along as we've gone through all of this, the downside really has been a case series does not a new therapy automatically make. So while it might be really great that somebody had a case and then there was a bunch of cases in the hospital and all this. That were positive, that doesn't generally change policy. Now, what you saw in China was that they had so many patients so quickly, because that's probably where it all started, and their hospitals were becoming overwhelmed, that they were willing on the strength of 1 or 2 cases to do it with more people. And so it became a more standard type of therapy on the strength of the cases. What we saw here in the United States was, with the very few exceptions, is the more normal or typical thing that happens in the US and certainly Canada, where you're going to wait for the scientific machinery to catch up with these case reports and do some other studies. Now I will say that somewhere around a little under probably 1% of hospitals in, in the US and Canada did start to use intravenous vitamin C early on, on the strength of a couple of things. One was safety, generally recognized as safe. Number 2 was that they were already using it in other bad illnesses such as sepsis. And number 3 was the overwhelming idea in those very few hospitals, and again, it's about 1% or less of hospitals, that we don't really have any other treatments. And so even if this is neutral, meaning it's not better or worse, it's inexpensive, it's safe, and it has a chance of helping, so we're going to do it. Now, if you take that as, well, that's pretty good, that's, you know, fairly forward-thinking for a therapy that's not entered the mainstream, and that's pretty good. The problem is that it's about 1% of hospitals or less, and so your chance, if you needed to go to the hospital, of being offered intravenous vitamin C is pretty low because 1% is not a lot of the hospitals throughout North America. So then things started happening because I was doing these courses and, you know, informing physicians and hospitals and others about how to use vitamin C, why it might work, et cetera. So I would get called by families of people, unfortunately, who were in the hospital with COVID and in an effort to try and get that hospital to maybe try intravenous vitamin C. I was, you know, brought in either as an expert or something of that nature. The other thing that happened really early on, and we're talking about March, you know, again, was a couple in the United States, a couple of the states in the US, and no, I won't name which ones they are because of things that may become obvious pretty soon. Department of Health asked for information about how— this is from the State Department of Health— how would hospitals implement intravenous vitamin C such as they did in China if we wanted to do that as part of our emergency authorizations from the state level? And so you've heard we've had a whole program about, you know, emergency use authorizations and biologic drugs and the COVID vaccines and all that stuff. That's a federal level. Well, there's also a state level where if the state has any reason to declare a state of emergency, they can implement certain things statewide that you wouldn't otherwise be able to do, and this was something that was on the table that might have been done. Well, as it turned out, after I prepared These essentially, you know, training and implementation protocols or manual, if you want, for hospitals to use IV vitamin C. They were not implemented as part of any emergency, you know, any emergency act in those states, and it was pushed back to the individual hospitals to decide what they wanted to do. Well, that was all a good exercise. It did get some help for some people, and as I said, there's about 1% or less in North America of hospitals using IV vitamin C. So all in all, it was not, you know, a complete dead end. But in the intervening time, one thing that kept happening, which of course I knew was going to happen, was the establishment would say, well, you you know, we don't have any randomized controlled trials or controlled trials on the use of vitamin C and COVID, which of course we don't because it was a brand new disease entity. So there would be no way we would have it. We had some on, you know, sepsis, as I said, and some other things. So what happened, thankfully, early on was a number of centers in usually in hospitals or educational institutions around the world saw what the Chinese experience was with intravenous vitamin C in their hospitalized patients with COVID These centers in different places around the world set up control trials, so actual studies with COVID patients, humans, to say if we do implement intravenous vitamin C, can we mimic the same positive benefits that we had in China. And what else can we find out? Now, there were a lot of things being studied in China as they went along, but if you can imagine, they were trying to do everything all at the same time, and they were just collecting a lot of information. And so a lot of these studies then, when they were set up after the fact, said, well, let's look at, you know, these parameters and see if 5E vitamin C changes these things. Well, waiting, waiting, waiting almost a year for any of them to be published. Now there's 2 I'm going to talk about today that finally got published and went through peer review and all of that, so they're out there and I have references and all of that. And there's a number of other ones that are still pending, meaning they either haven't finished their trial yet or they're Waiting to go through peer review or something of that nature. Now, that is a great thing. It's really good to have, you know, peer-reviewed science and data. So I wanted to take that information and update it. The other thing I want to talk about was something that just came out a number of weeks ago, just a few weeks ago, and that was a study around the oral use of vitamin C, the oral use of zinc, oral use of the combo. And I wanted to go Go through that study as well because it's gotten some press also. But let's start out really quickly. Why would vitamin C be necessary when you have someone sick with something like sepsis or COVID or whatever? Well, the first thing which we've talked about quite a bit is that vitamin C is not made in the human body. Other animals make it, humans don't. Okay. Why is that important? Well, all the vitamin C we have, we get from eating or drinking it, right? If we have an illness, our vitamin C levels go down. And if the only way of vitamin C coming into the body is by me eating or drinking it or taking it, and I don't have any going in, as my levels drop with illness, I'm going to get sicker. Why? Because vitamin C is very important for a number of critical immune activities, but also, and this is something we've talked about on and off the entire year around the immune system, vitamin C is very responsible for a critical part of the immune activity called modulation, which means that we have— modulation means I go up when I need to increase immunity, but I don't go too high. I go down when I need to calm it down, but I don't go too low. Right. The immune system is very dynamic. Well, vitamin C is involved in the modulatory part of the immune system. It's also involved in the prevention side of the immune system. It's involved in the killing side of the immune system. It's involved in a lot of places. So if I have this nutrient like vitamin C that I as a human and you all humans who are listening don't make, and it goes down when I get sick and it's part of my immune function, then And that might be a good thing to have around. Okay, so that's why it's so necessary. Now, what they had already shown in studies around people who are hospitalized with sepsis is vitamin C levels do definitely go down when we get sick. And if vitamin C does all these positive things for my immune system and it lowers when I'm sick, well, when I'm sick is when I need my immune system operating as normally as possible. Right. Now, there's a little terminology that is really good to just think about. A lot of people have talked about it, so I won't go too deep, but that's the idea that the immune system, we're not really, when you're trying to treat somebody who's ill, you're not generally, with some exceptions around certain drugs, et cetera, you're not generally trying to stimulate the immune system and thereby just raising its activity. Because the immune system runs on this sort of sine wave, this sort of up and down activity, and that's part of natural immunity and the natural way that the immune system works, what you want to do is give it all of the necessary underpinnings and substrates and, you know, all the fixins, so to speak, to create good immunity, and then let the natural internal control mechanisms do what they will with it, which means it's gonna go up sometimes, It's going to go down sometimes, but it works within a certain band. So when we think of enhancing immunity, what you're really doing is just supporting it, giving it a lot of support so it does the job it's supposed to do to start with. Well, if you're sick and your vitamin C levels keep dropping, it can't do the job it was supposed to do. Now, the next thing, as far as some of the background about what would we do with vitamin C and why would it work, Is oral vitamin C, and this is what their theory they were going with in China, was if you're not in the hospital, we don't want you to come to the hospital, right? We would prefer you stay out of the hospital because your chance of living is better, and the last place you need to be unless you absolutely have to be there is in a hospital. And that's kind of universally true, but especially when there's an epidemic or a pandemic going on. So what they did is they distributed vitamin C to people to take, and that they believe was helpful. Now, the other thing, which I talked about a year ago a few different times, was they used their own indigenous medicine, which happens to be China. So it happened to be traditional or classical Chinese medicine, and they did report that that was also beneficial, which makes sense. It's a constitutionally based type of medicine, uses a lot of herbal treatments, certain types of diet alterations, sometimes acupuncture, etc. And what I had said over and over, you know, a year ago, 9 months, 10, 11 months ago was whatever Indigenous medicine you have available to you is kind of going to be the same. It's constitutionally based, it would be helpful, right? So they were doing a lot of things. Now, why would there be a difference If especially you're in the hospital, between, you know, let's say I am writing the orders for what you're going to get as a COVID patient in the hospital, why would there be a difference between me just putting on your orders that you should get a certain amount of oral vitamin C while you're there in the hospital, especially the ICU, versus having it go in? To your vein intravenously. Well, certainly in the critically ill folks in China, and it was about 50+ people who got IV vitamin C, there was about 380 patients total, so most didn't get vitamin C and the ones around 50+ did, but they got intravenous vitamin C when they're in hospital. Why would that be? Well, Partly it's because if your levels are dropping and you're critically ill, you can raise your levels much faster if it goes into a vein. Okay, that kind of makes sense because you're not eating it. If you're out of the hospital and you're doing it for supportive and preventive purposes, that is not as necessary or not at all necessary in some cases. Okay. So When you're thinking about that, if you're in the hospital, IV is likely to be more helpful. Now, what I can tell you in the intervening time, as I said, there's been a lot of, you know, families that I have spoken with, and they've asked me to talk to the, you know, the doctors at the hospital and all of that. In cases where they have an ICU, an intensive care patient who has COVID, In those cases where they would only give them oral vitamin C, but they're in the hospital in the ICU, those people did not do as well as if we could get them to give intravenous vitamin C once they were in the hospital with COVID Same exact experience as was seen in the patients in China. So IV does make a difference over oral. Now, yes, for purposes of repletion and nutritional purposes, etc., if you're not in the hospital, you can get a lot of benefit from it orally. And what we always talked about with taking it orally was what? If you take too much vitamin C orally at one time, you probably get loose stools or diarrhea, so you spread it out throughout the day. A benefit of intravenous vitamin C is you don't get that. You don't Get the diarrhea effect from intravenous vitamin C. Now, the next thing that came up just by way of, you know, comparison, because this is certainly a hot topic and one that a lot of people have brought up over time. The next thing that was really, you know, of interest to me because it's an area of work I've done, but also, you know, something we would wind up explaining Was people who did IV vitamin C in the United States and Canada and other countries would often say, well, it doesn't look like they're using enough vitamin C in the hospital. Why is it working? Now we'll talk about doses coming up, but just for the sake of comparison, if you look at IV vitamin C that is normally done in, say, most places, but let's pick North America, for a patient for an immune purpose chronic infection or cancer support, something like that. They may do very, very high doses of intravenous vitamin C that might be 2 or 3 or 4 times as much as what was being used in the original hospital doses in China. Now, what I can tell you is if you look at the case reports, there were cases in China when people were dying and they decided to give them 2, 3, 4 times as much, and in a couple of those cases, the person and wound up not dying. They pulled out of it. They pulled out of their respiratory failure and they lived. But generally speaking, compared to what a doctor who does intravenous vitamin C, as I said, for cancer support or infection support or whatever might do out in an outpatient setting, these are lower doses. Now they call them high dose because they're higher than you would normally eat, but they're lower doses. So that was another conversation that went on a lot in March, April, May, June. Of 2020. Now, is, is it better? Is it not better to do these, you know, higher doses, etc.? What I will say, and this is not part of any study, so here we're going back to sort of case reports. What I can say is when we in the North American area have had patients who test positive for COVID, they've got all the symptoms, they're very sick. But they don't need to go to the hospital. When we have given them higher doses like 50 grams, so 50,000 milligrams, 75 grams, we have seen very positive results and kept them out of the hospital with those bigger doses. But then you have to think about what goes on in the hospital that would be different from going into a outside clinic to get, say, an intravenous treatment with anything, let alone vitamin C. Well, in a hospital, there's a number of other things going on. One is you, you don't generally come and go, especially if you're in the ICU. You're there, you're there 24 hours a day. The upside of that is they usually have an IV running, and so they have vascular access to you 24 hours a day. In an outpatient setting, you're usually there for a short time. 1, 2, 3, 4 hours. Okay, so the dose and the speed of the IV is totally different in an outpatient setting versus an inpatient setting in many cases. The next thing is, and this goes back to that idea of modulation where we want to support, we're not really trying to drive things too high or too low, we want to support, and we want to support the natural immune function that It goes up and down in this kind of sine wave pattern to do its job, and we don't want it to overreact because remember early on everyone was scared of, rightly so, the overreaction that killed people, cytokine storms, cytokine response syndrome, that sort of thing. That's an overreaction of your immune system, so we don't want that, but we also don't want it to keep going down. So if you're more critical and you're actually in a hospital, There may be some benefit to doses being a little bit lower, but more persistent all, all day long, for example. Now, the most common dose that was used in the original case series, and as I said, there were some that did higher, some did lower, but the most common dose was what worked out to be 1,000 milligrams or a gram every hour. So every 24 hours you had 24 grams 24,000 milligrams or 24 grams of vitamin C. So when I was writing these protocols that were originally being asked for by some of the states and hospitals and things, that's what I wrote because that is an easy thing to implement in the hospital, and it is also, it's easy for the pharmacy, the nursing staff, everybody. It matched the most common dose that was getting good results in the case series in China, And so that was the one I chose to write about, and that's the one that's been used most commonly. One of the studies that was published used that type of a protocol, 24 grams in 24 hours. Now, if you're thinking, well, gosh, you know, I go to an outpatient center and I get 50 grams, 50,000 milligrams, or 75 grams, 75,000 milligrams in You know, 2, 2.5 hours. Why are you giving 24 grams over 24 hours? Go back to this idea, if you have a more critically ill person and what we're going for is supportive modulation, putting the vitamin C in what we consider kind of low and slow, even though it's a higher dose than you would ever eat, turns out to be quite helpful in the hospitalized patient. So where did these studies go? What do we know about these studies? Well, when you start to think about, you know, oral versus IV, the first thing is, if you're in the hospital, you probably should be doing intravenous, because as I said, there's a lot of hospitals— there's like 1% are doing IV. There's a few more where they're giving oral vitamin C to their COVID patients, which is great, but it might be too little too late at that point. So there are 2 published studies. As I said, there's others that haven't published yet. One of them had 150 patients total, and they have a placebo arm where they got basically nothing, you know, saline in their IV, and the other where they got the vitamin C. So 150, 75, and 75, and they were equally divided. They're all hospitalized with COVID And then the other one had 56 patients, and they had a division of 29 in the placebo and 27 in the treatment arm. That's just the way that the numbers worked out with a little bit of dropout and things of that nature. So it was a smaller group, but they were getting the 24 grams over 24 hours. So in the first group where they had 75 patients in each side, 75 getting a placebo, 75 getting the vitamin C, they did it on a body weight dose. And so the average adult, which is just a construct of pharmacology, we call an average adult 70 kilograms or 154 pounds. The average size adult would get about 3,500 milligrams or 3.5 grams every 24 hours. So a lot less of a dose. Now, these 2 studies that have published measured different things. Some of the things were similar, but they measured a few different things. But in the studies, this gets to part B now that we want to talk about, which is when you have a study and you publish it, there's always statistics attached, right? So how many people, how many people got a benefit? And then the next thing is, if there was a benefit or no benefit, did that benefit or no benefit reach what we call statistical significance? It becomes important because if numerically it doesn't reach statistical significance, you can, if you want, report on, you know, the finding, but you have to, you know, call out that it It probably is not a discriminator. It doesn't really mean anything because it didn't reach statistical significance. And the underlying part about statistical significance is it is a mathematical way to say the difference that we saw is meaningful beyond random chance or some other factor. It is meaningful in that it is probably due to something that intervened. Now, if the intervention was intravenous vitamin C and that was the change you made, and the placebo group and the vitamin C group, that was the difference between the two, and you have statistical significance, then that means that that is a meaningful difference, whatever you found, right? So in both of the studies that were published, and this is summarized, and I'll give you a place you can get this all of the write-up and all of that and all the references. But when I summarize this, I made sure to report on the statistically significant parts of each of these trials. What was really nice is both of the intravenous doses, even though one was much higher than the other, showed benefit in statistically significant ways with a few different things. Now, in the lower dose study, Where they gave an average 3.5 grams, 3,500 milligrams over 24 hours. The people in the IV vitamin C arm, the people getting the treatment, had a shorter amount of time before they were symptom-free. So it was about 2.5 days less to become symptom-free. Now, the important part about that is, is that If you're going and looking at symptoms, of course you have to be looking at how they're reported and all that. But if your symptoms go away quicker with a treatment, that is important because that's less time that you have evidence of the disease and less time you're going to have other problems from the disease. The other thing that was important was the hospital stay was shortened by about 3 days. Now there's a couple of things about hospital stay time. One is it's very expensive to be in a hospital, especially in, in the United States. That's expensive everywhere, but in the US, you know, we've elevated the cost of hospitals to an art form. So 3 less hospital days is millions upon millions of dollars if you extrapolate that over everybody who has to be in the hospital. So symptom-free, 2.5 days, about 3 days shorter in the hospital, and both of those reached statistical significance. Now, the low-dose study did not reach significance for anything else that they checked, which means you can't say it was better or worse. And so things like mortality, Need for ventilators, all of that, those didn't reach a statistically significant difference between treatment and placebo. And so it doesn't mean it was better or worse. It means we don't know. When there's no significance statistically, you can't say it was better or worse. You say we had— we don't know, it didn't reach significance. Now, what about the other one, the other study? That's by Zhang et al., where they gave a higher dose. Now, this one, they wanted to get a bigger number. Remember the first one, the lower dose study at 150 people, and they divided up 75-75? Well, in the second one, the second one I'm talking about, they're not going in any order, they gave more vitamin C. So it was 24 grams every 24 hours, and they wanted a bigger number, over 100 like the other study, but they cut the study off at 56 people, not because they didn't want more numbers, but because in this particular hospital they ran out of COVID patients. Okay, so they couldn't keep enrolling because they were not getting enough new COVID patients to keep enrolling in the study. So they capped it off at, as I said, 29 people in the placebo arm, 27 in the vitamin C arm. Now, the lower number of people you have, the harder it is to gain statistical significance. Now, in this study— and you can get both of the studies in the links that I'll share in the paper that I wrote that you can get for free— They looked at all sorts of things, but only a small handful of those things reached statistical significance. So only a small handful we can report that there was benefit or no benefit on. Okay. So the first thing is, in both of these studies, and this is a big question that the hospital people, whether it's the pharmacy nursing staff, the physician staff, Very good question. That's always asked first is, does the vitamin C addition make me change anything about the other drugs and treatments I'm doing for them while they're in the ICU or hospitalized? And the answer is no. In none of the cases were there any drug interactions. In none of the cases did they have to stop any of the drugs. So you still got all the same intensive care or hospital-based treatments. You just added the vitamin C intravenously into your therapy. The other thing that was in both of the studies that was universal was nobody had to be taken out of the study because of a bad event, an adverse event with the vitamin C. So that's important also. So these are all good markers, but in this study where they had lower number of patients, it's harder to get statistical significance, but they had the higher dose. So 24 grams in 24 hours. And so when they looked and they found significance in certain areas, again, things like mechanical ventilation need and overall mortality death were not significant, so there's no reporting on that, okay? But what is interesting is while the overall mortality in gross numbers was not different. The probability of dying, and there's different ways statistically to look at that, is lower if you got the vitamin C. Now, probability of dying is a, is a number that looks forward, whereas actual mortality is who died during the study. Those are 2 different things to look at. Okay. It's important when you have probability of death being lower with a treatment, because that means if we do put this over and it was statistically significant, we put this over a larger number of people, we are going to have more people surviving. Now, what else was different? Well, even though we had no significance in ventilation time or any of that, There was a very critical lung function measurement that they didn't measure in the other study, I don't believe, that reached statistical significance. And the bottom line with this— this is called P/F, which is a measurement of how your oxygen is getting into your lungs and then in your tissues— was better in the vitamin C group. That's— you want it to be higher, you want it to be better. It was actually 1.5 times Higher than the placebo group. This is important because that number talks about oxygen getting to your tissues, which has a lot of downstream effects. Number one is less likelihood of dying, but also more likelihood that you are going to heal and get if you're on a ventilator, get off of the ventilator. Another finding, and they measured a lot of laboratory measurements in this one. Another finding that was very, very important was interleukin six. IL-6. Now, if you've read about the infamous cytokine release syndrome, cytokine storms, people dying and all that stuff from this cytokine response, IL-6 is the target. Now, there's many other things, but IL-6 is sort of a linchpin there. Interleukin-6 was actually 8 times— 8, okay, 8 times lower in the vitamin C group than the placebo group, and that was a statistically significant So it wasn't just a little bit lower, it was a lot lower. And by lower, what we mean is these people are— when you're sick, that goes up. If it keeps going up, you have a triggering of a cytokine storm and you might die. So we don't want it to go to zero, but we want to go back into the normal range. And what it did in the non— in the placebo group, the no treatment group, they were just getting regular ICU treatments, it just kept going up. Yeah. And in the vitamin C group, it went back down and headed towards normal. This is very important because some of the drugs that are getting looked at and being given emergency use authorization for hospital use are biologic drugs that manipulate interleukin-6. And so that's great, and it's good to have those, but if you have a treatment that can affect your oxygen levels, tissue oxygenation, and lowers your propensity for death death and all these other things and tones down IL-6, and it's a tiny fraction of the cost of some of the new biologic drugs, why not use it? Why not use all of them? Okay, vitamin C is that agent. The other thing, as I said, there are no negative interactions between vitamin C and the standard hospital therapy. So if you're in the placebo group, it wasn't you weren't getting treated. You're getting everything the hospital has for you except If you're in the treatment group, you're getting everything the hospital has for you plus vitamin C. Okay, so no negatives, no one was taken out or thrown out of the studies or fell out of studies because of adverse events from the vitamin C. And the things that did reach statistical significance were of great note. Things such as shorter amounts of hospital stay, improvement of oxygenation, decreasing the propensity towards death, et cetera, et cetera. And then the IL-6, the interleukin-6 data, which is very, very compelling. Now, I will give my estimation of which of the protocols, if it were me, I would do, or I would want if I was the patient, but we'll circle back to that. One other thing I had said I was going to talk about, so I wanted to make sure we got a chance to get to that because we do have— we've got time for it. So in the famous Journal of the American Medical Association, also sometimes called JAMA, J-A-M-A, Journal of the American Medical Association, there's a publication that came out, let's say a month ago. I've got the study cited. And don't have the date in front of me, but it was— it had one of these sort of long titles. It was the effect of high-dose zinc and ascorbic acid supplementation versus usual care on symptom length and reduction among ambulatory patients with SARS-CoV-2 infection, and it was called the COVID A to Z randomized clinical trial. Now, in all of these trials, the 2 IV ones and then this one, They were randomized controlled trials. And so what that means is, is that you have a placebo group and then you have a treatment group and you, you, the study designer, generally, if they're randomized, you don't pick it. It's just, you know, person 1 gets the envelope with what their protocol is going to be, person 2, person 3, and When they, so to speak, open the envelope or put the codes in, you don't know that person 1 is getting the treatment and person 3 is a placebo, etc. Okay, so it's randomized. That's supposed to help take out some of the irregularity, which is true. So that's what they did with this. Now, basically what they did is they had 4 groups in this one because it was oral. One group's placebo. That's easy. They're getting just standard care with no nutrients. Next group is oral vitamin C. Next group is oral zinc. Now you've heard us talk about oral zinc and vitamin C. The 4th group is zinc and vitamin C. So this looked like a really cool trial, and it would be really great if we could show that, you know, what does it do when we give people oral vitamin C or zinc or individual together or nothing? And can we say that there is a treatment that, you know, is superior? Now, Now you never know when you start to do a trial if anything's gonna happen or not, but wouldn't it be real interesting if, for example, the vitamin C and the zinc together, which is what we've been telling people to take, that was way more of a positive intervention than just vitamin C or zinc individually and way better than the placebo? But then you could also find out, well, vitamin C outperformed the other ones. That's how you would see it with, with one of these trials like this. That's the positive side of doing the trial. Here's what happened though. And so the, the trial got published. What they did is they set— and so there's numerical values called p-values, then there's other statistical numbers that are looked at. And so they set a numerical value that This is statistically significant. And if we see one of the 4 treatments, so nothing, vitamin C alone, zinc alone, or vitamin C and zinc together, if we see one of the 4 treatments getting statistically significant and in this level that's better than the others, we will call that a clear— clearly beneficial treatment. Okay. Treatment. Great. Okay. The problem was that they stopped the trial because they were not seeing any any of the treatments as a clear winner. The next problem, though, is if you just look at the title of the trial and then the fact that there the trial was stopped because nothing was better than anything else, you might. make the conclusion, which I've seen reported in some, you know, some outlets, that vitamin C or zinc or vitamin C and zinc together had no benefit. The problem with making that conclusion is, remember when we talked about the IV trials, I said I didn't report on anything that didn't reach statistical significance. None of them in this trial reached any statistical significance, which means you don't know. We know that there was a trial done. We know that there were these 4 different groups, one with just placebo, one with just vitamin C, one with just zinc, and one with zinc and vitamin C. But their outcomes, partly because it was stopped early and partly because of the The numbers used did not reach any statistical significance by a long way. So the numbers, the values that are assigned that indicate significance were not reached by anything. So this trial from JAMA that is, you know, being used to say, well, vitamin C and zinc orally or in combination didn't didn't help actually can't be used to say that because we don't have significance to know that anything happened, right? So if you're going to report on outcomes of trials, you have to use the same rules. No, you don't have to because people do it whatever way they want, but you should use the same rules, which is why on the 2 IV vitamin C Trials. There's lots of data, but I only summarized and reported the ones that reached statistical significance because the others are meaningless. In the case of the trial that was published in JAMA, it is of curiosity note; it's of historical note, and it might help somebody design a better trial. But the data don't mean anything. You cannot say from that trial that vitamin C, zinc, or the combo is better or worse than a placebo. You can't say either way because you don't have the statistical values to say any of it, right? So in that one, and that one is in this, it's in the summary as well, I just want to caution people, if you see that and you see it reported And I've seen reports that say vitamin C and zinc are of no help to patients with COVID Well, it's not true because you can't say it from that trial. You can't say it's helpful or not. It's a zero. It's nothing. So we are down to just a few minutes left here. I'm gonna take a little water. But I just wanna talk about a couple of things in summary. My experience, and I go through this in the summary I wrote for the paper, my experience with hospitalized patients so far has been if you get to the hospital, you're way better off having IV vitamin C than oral, because we have had some hospitals where they do the oral, but by the time you're in the hospital, that may be too little too late. My hope is that these trials that are getting published that have significance statistically and that match what we've been writing and we've been talking about and what the cases have been saying will push the establishment to be a higher level than 1% of hospitals using intravenous vitamin C. Is it a cure? Is it a panacea? No, but it is— is it a very available FDA-approved drug that is very inexpensive compared to most other drugs being used? Yeah, it's all those things. I even tell people because the hospital pharmacies aren't using it what the name of the FDA-approved version of vitamin C for infusion is. So it's useful, it's beneficial, it's got statistical significance, and you can read all about it. Now, Best way to find it, you can go to any of my social media, but DRA Online on Instagram or DR.A Online on Facebook. I've got links on my Instagram in the Linktree, and there's 2 different links. The last one is IV vitamin C COVID update, and it's published paper, and it has all of this in it. Well, we're out of time for today. This is Dr. Paul Anderson with Medicine and Health with Dr. Paul Anderson. And I would encourage you to go and read that. Again, just go to DRA Online on Instagram, or you can go to www.dranow.com and also find me. But I'm out of time, so I'll see you all on the radio in one week. Have a good week.