It is hard to overestimate how wonderful it would be if hydroxychloroquine worked. The long search for a pharmaceutical intervention in the progress of the coronavirus would come to an end, not with a new compound that’s difficult to manufacture, but through the re-purposing of a fairly simple one that’s already in wide use. It would be an epidemiologist’s dream come true: a cheat code to the pandemic, a plot twist at the end of a feel-good movie. We already know what the drug does, we know its risks, and we know it’s pretty well tolerated. Hydroxychloroquine can be dangerous, but it’s not the sort of pharmaceutical that turns the patient inside out in order to cure her. It’s cheap, and, like all treatments administered by pill, it’s quick and easy to administer. There’s not a doctor alive who wouldn’t be delighted to share the good news with her patients.
Unfortunately, there’s still no evidence that it does any of the things that its proponents say it does, and there’s mounting evidence that it doesn’t. The latest medical publication to cast doubt on the usefulness of hydroxychloroquine is the Lancet, which just published a large observational study about the drug. The doctors who ran the study looked at hydroxychloroquine taken in isolation, and hydroxychloroquine taken with azithromycin, an antibiotic that has also been anecdotally linked to the alleviation of coronavirus symptoms. The bottom line: neither approach worked. Patients given hydroxychloroquine, in any combination, had significantly poorer outcomes than those who weren’t.
Hydroxychloroquine enthusiasts responded as they always do: angrily, and with absolute conviction that they know how to run medical studies better than those trained to do just that. The study was too big, or it wasn’t wide enough, or the timing was all wrong, or they didn’t give the proper combination of supplementary drugs in the proper sequence, or the results are automatically disqualified because the Lancet is in the pocket of a pharmaceutical industry looking to push vaccines instead. The theory among those who take a ride-or-die view of hydroxychloroquine is that the drug creates conditions under which other drugs — zinc, in particular — can interfere with the replication of the coronavirus, but if that process is started too late, the progress of the pathogen becomes irreversible and no amount of medicine can help. A study that focuses on people who’ve already been hospitalized isn’t useful. They’re too far gone. The hydroxychloroquine needs to be given during the first stages of illness, or even prophylactically, in order for it to do any good.
For researchers who want to take hydroxychloroquine seriously, this creates a methodological problem. Early-stage or asymptomatic studies aren’t easy to conduct. The coronavirus is a very dangerous pathogen, and case fatality rates and hospitalization rates continue to be scarily high, but most of the people who get sick aren’t going to die, and they aren’t going to be hospitalized, either. Most of them are going to recover on their own. Patients who never get seriously ill may attribute their recoveries to hydroxychloroquine; they might just as well put it down to prayer, or fresh air, or a lucky rabbit’s foot. This puts those who are committed to touting hydroxychloroquine in an unassailable position. If a patient takes the drug and dies, well, too bad, that meant he started too late. Only those who take it and survive are worthy to be counted, and when they’re counted, their recovery is attributed to the drug.
Logic like that might be gratifying to entertain, but it’s medically useless. It generates the sort of tautology that I associate with the Catholic Church at its worst. If a patient recovers, that proves faith in the drug is properly placed, and if she doesn’t, she must have done the drug wrong. Humans are faulty; only the drug is unquestionable. Those doctors and researchers who doubt the power of hydroxychloroquine aren’t just incorrect, they’re downright evil: they’re participants in a grand global scheme to suppress a cure.
Is this possible? Sure it is; the history of the world is full of examples of large groups of people doing pernicious things. But I do wish that the many who commit acts of casual calumny against the Lancet, and other publications like it, would understand the breadth of the accusation they’re making. They’re not merely accusing doctors, researchers, and drug companies of conspiring to kill millions. They’re suggesting that people who are actively involved in the treatment and attenuation of the pandemic would be unwilling to take a simple measure to check its spread, thereby putting themselves at greater risk of catching the coronavirus and dying horribly. I am a paranoid cuss, but that’s a bridge too far for me.
I don’t believe the burden of proof always falls on the skeptics. I just think that if you’re going to make a world-shattering claim in the face of good evidence to the contrary, gathered by professional evidence-collectors, you ought to have the common courtesy to back it up with something substantial. Anecdotal accounts from country doctors aren’t going to cut it. We’re all frightened, and we’ve got good reason to be; we’re going to be rummaging through the ammunition drawer for magic bullets. Alas, viruses are rarely defeated outright by a pharmaceutical. Even vaccines are only partially effective. The way we beat this thing is by putting in the work — wearing masks, and keeping our distance and behaving responsibly, reconfiguring workspaces and redefining the idea of work, improving ventilation, and making sacrifices to drive the reproductive rate of the coronavirus down to zero. None of that has been fun, and the things we’re going to have to do in immediate future won’t be fun, either. But it’s all necessary. And I can’t help but notice that some of the loudest advocates for hydroxychloroquine have been people who don’t like to put in work — lazy people, ones who’ve made careers out of cutting corners and chasing easy solutions for complicated problems. I don’t expect them to back off any of their claims, because that would require them to think, and act, and those are two things they’re always reluctant to do. Just remember when you hear them talk: if they were right about the game-changing powers of hydroxychloroquine, the pandemic would be over by now.