I want to make sure NR readers don’t miss this essay from Norman Doidge. It’s the best thing I’ve read on hydroxychloroquine. But beware: The piece is long and fascinating. Once you start reading, you won’t be able to stop, and it takes a good half hour to finish.
Doidge tells the tale of hydroxychloroquine, or HCQ as he calls it, as if the drug were a character in a story. His main point is that HCQ hasn’t received fair treatment in many quarters, including, unfortunately, some of the health experts advising the government of the United States. The main reasons are the intrusion of politics into medicine, the pitfalls and limitations of big data in medical science, and the over-reliance of many experts on random controlled testing to the exclusion of other kinds of evidence.
Doidge manages to make even a discussion of research methodology interesting. Here is a sample:
We now have studies that show one of the weaknesses of RCTs (random controlled testing) is that in the quest to eliminate confounding factors, they end up, in a majority of cases, excluding patients who are typical of those in the population. The RCT evangelist focuses only on the RCT strengths, and forgets their weaknesses. A typical RCT describes several data points about hundreds of patients. It can be helpful in determining what treatment might work for most people in a large population. A typical case history describes perhaps hundreds of data points about a single patient. Its focus might be on what treatment might work best for this patient. Sometimes we need all that information about a patient, to choose a proper treatment, because individual patients differ, often in decisive ways.
Patients are not “several data points.” There are multiple good reasons that the medical curriculum and major journals and texts publish RCTs, observational studies, case histories, and other designs, and why most physicians with experience will use what I would call the “all-available-evidence” approach and take, as appropriate, what they can learn from different kinds of studies, and of course everything they know about their own patient in front of them, to decide on a treatment. That is what personalized medicine is about. RCT fundamentalists — who believe only in their randomized data and essentially argue for throwing away everything else — pose as people simply expressing the conventional view: All you need is one tool. But in practice, they are way outside it. When the teacher tells you to quit paying so much attention to the fullness of your experience, pay more attention to why he might be saying so.
Doidge makes a powerful point in his conclusion: that the same medical community which is telling us that HCQ is dangerous — even though it has been in common use for 60 years — may in a few months be telling us that a vaccine developed in record time is completely safe.
If you think this year’s controversy is bad, consider that hydroxychloroquine is given to relatively few people with COVID-19, all sick, many with nothing to lose. It enters the body, leaves fairly quickly, and has been known to us for decades. COVID vaccines, which advocates will want to be mandatory and given to all people — healthy and not, young and old — are being rushed past their normal safety precautions and regulations, and the typical five-to-ten-year observation period is being waived to get “Operation Warp Speed” done as soon as possible. This is being done with the endorsement of public-health officials — the same ones, in many cases, who are saying HCQ is suddenly extremely dangerous.
This outstanding article reinforced an opinion I had already reached. I think HCQ has therapeutic benefits in treating COVID-19; I’m confident that, used with proper medical oversight, it’s harmless.
Read the whole thing.