Covid-19: Dr Cadegiani's patient number 3711

Everybody knows that for science, anecdotal cases do not prove the efficacy of anything. But I am not discussing here the efficacy of drugs against COVID-19.

Phtoto: CDC/Unsplash

"My father tested positive for COVID for the second time. The first time he almost died. Do you have the contact information of the best doctor for this, Dr Flavio Cadegiani?". This was the message I received on Sunday, May 29, in the evening, while I was listening to a samba circle in a café on the street near my house.

Who sent me this message was a person who contacted me on Twitter shortly after I wrote the article "The day I understood the 'Good German'", published in the Jornal France Soir, in Paris, in February this year. It was one of my texts about the pandemic that had the most viralization. He started to follow me on social networks after reading it.

The way this person, whom I will call "Jota" to preserve his identity, contacted me was unusual. He, in the very first message, offered me money. "We are businessmen and we would love to contribute, in case you want to produce this film. Yes, your text is the perfect script for a historical film," he said.

He introduced himself, said that he and his wife fight against the pseudo-consensus of the pandemic. I thanked him for liking the text and replied that a documentary about that article could be made. "It helped me a lot to understand what is going on today." he said.

In the aftermath he made a comment that explains a lot of the current moment about any conversation addressing the pandemic. "We fight sometimes within our own family." Curious, I googled his name to see if the proposal might be something to be taken seriously. He is a successful entrepreneur. It has been more than three months since the offer and the subject has fallen behind, dormant. Sometimes, when watching some documentaries, I catch myself thinking about the subject, just ways to tell the story.

But I didn't keep close contact, until I received a message from him, asking for Cadegiani's phone number, so that he could attend to his father. "I can do it. If not him, it will be someone very good, equal in attendance," I replied. This is not the first time I have helped bring people seeking treatment from COVID closer to doctors who provide early treatment. But his request was absolutely clear: he wanted his father to be treated by Dr Cadegiani. "It's not a cost issue," he stated.

Jota told the story, the reason for his concern. The first time that his father had COVID, last year, his lungs were severely compromised, he was hospitalized for a long time and almost died. "I stayed 30 days with him inside the hospital. It was a lot of struggle. After it gets complicated it is very hard," he lamented.

"Each week his lung condition worsened, and then developed into a pulmonary embolism. More than 90% of his lung was compromised. It was a nightmare," he explained. "He couldn't stand on his own, he couldn't take a shower, he couldn't do his physiological needs, because he had no strength," he added. "Our world stopped for a month."

Dr Cadegiani, meanwhile, the doctor Jota sought to treat his father's COVID, is an old familiar figure in the national media. "Accused of crime against humanity in CPI prescribed unprecedented dose of proxalutamide to patient with covid-19," said the headline in El País Brazil in October 2021.

"Flavio Cadegiani is the doctor responsible for a study with the same drug that may have led to the death of 200 people. The case occurred in Brasilia, in the endocrinologist's private clinic, where he was treated with a drug being tested without the necessary ethical and scientific support," explains the news release.

In the portal of Globo, the largest communication group in the country, the headlines were in the same direction. "Covid: Proxalutamide tests in the Amazonas state could be one of the most serious violations in Latin America, says Unesco researchers". Then Unesco backtracked, but that became just a footnote.

Cadegiani, since the beginning of the pandemic, has done several studies with various drugs to fight the disease. He researched hydroxychloroquine, nitazonixanide, ivermectin, and proxalutamide. All, according to the Brazilian media, "without proven effectiveness", despite the studies concluding positively. 

The website of the Questão de Ciência Institute, which aims to promote national scientific debate, stated that the study with proxalutamide, which concluded in a 78% reduction of deaths in hospitalized patients, is in fact unreliable. "The results, unfortunately, are nothing more than an expression of systematic errors and the lack of experience of the researchers involved," the story explains. They even cite a critique of the study in the journal Science, which summarized the proxalutamide result as "too good to be true."

In the meantime, entities that have analyzed the raw data from the proxalutamide study are giving it good recognition. At Canada's McMaster University, the birthplace of evidence-based medicine, the study was rated with one of the highest scores among all drug studies in COVID. They attested to the high quality of the work.

The same occurred with the analysis of the COVID-NMA site, linked to Cochrane, from France, which aims to analyze scientific evidence of treatments. There, they concluded that there is low bias, which proves the solidity of the work. The analysis of these two entities could be very deep because Cadegiani made available, by trusting and believing in his work, all the raw data sets in full for the world scientific community to analyze.

In any case, these acknowledgements of quality did not become headlines in the mainstream media, even when an independent group in the USA reproduced, also with positive results, the efficacy of proxalutamide, following the original theory proposed by Cadegiani to fight the pandemic. Only people who have started following Cadegiani on social networks know about this news.

While I was contacting Cadegiani to see if he could treat one more patient, Jota explained more details about the situation: "My sister is a biomedical engineer and she is always insecure, influenced by those people who are against early treatment.

During the exchange of messages, Cadegiani stated that he could attend to Jota's father. Knowing the possible resistance inside the house, I gave Jota a suggestion. "Then do the following. Instead of staying 30 days in the hospital, stay a week there at your father's house to see if he's really going to take the medicines." "You are absolutely right. I'll get on a plane now and go there," he replied.

And Dr. Cadegiani treated Jota's father. On the very first day, Jota, worried, thinks of a booster, possibly they were approached by someone who knows they are a family with resources. "My sister who is inclined to give Remdesivir to him," he stated. 

Remdesivir is a patented drug approved by the U.S. Food and Drug Administration (FDA) and recommended by the World Health Organization (WHO). It is sold in the elite Brazilian hospitals for about R$18,000, but even approved, celebrated, and stamped, it has not performed reasonably well. "Do everything Cadegiani says and don't invent fashions," I suggested. Jota agreed.

Cadegiani did the opposite of what the FDA and WHO recommended. He treated with a cocktail of generic, cheap, off-patent drugs, the same ones that he studied deeply and that are not recommended by these regulatory agencies. The next day, the patient had almost no symptoms. Three days later, calm, Jota was already on a plane to return to his city. With a rapid evolution and no more symptoms, his father's health did not cause him the slightest concern. 

Anyway, we all know. A single patient totally cured in three days says absolutely nothing for science. It does not serve to prove the efficacy of anything. This is known as an anecdotal case.

But on the other hand, this was Dr. Cadegiani's COVID patient number 3,711. Among all of them, the total he treated during the entire pandemic, Cadegiani had only four hospitalizations, a single intubation, and zero deaths. That's right. No one died. These numbers tell, in my way of understanding, a lot.

However, about the case, a conclusion can already be made. The countless headlines against Cadegiani have been proven ineffective.

Later, Jota informed me that Cadegiani did not charge for the service. I stated to Cadegiani that he was a rich family and that he could, without a problem, charge for attendance. "I don't charge COVID-19," he said.

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