The hydroxychloroquine drama

I do not personally have an opinion on hydroxychloroquine (hereafter HCQ). I’m not a medical doctor, and I don’t pretend to be one on the interwebs. But I do have decades of experience working with complex data modeling in the financial sector, and that training has made me incredibly skeptical of the data public health officials have been cranking out. And the media, forget it. They are innumerate idiots and political trolls. To say I don’t trust the media’s coronavirus coverage is pointless. I wouldn’t trust their coverage of the menu at a Junior League garden party.

But what gets me about this entire episode is the level of devotion big tech companies, the corporate media, and others have for silencing anyone who even mentions HCQ. I have never seen anything like this before. These platforms will allow bona fide hate speech all day long. Rappers, professional football players, and newspaper staffers can post vile stuff about Jews ad nauseam with no consequences. If you are a pedophile, there is no safer place for you than on Google’s platforms. Chinese propaganda and legions of sock-puppet accounts flourish on American social media. But if you mention this very simple, very boring pharmaceutical that has been used and studied for decades now – even if you are a licensed medical professional – then they will do everything in their power to de-platform you immediately. They even seem to have algorithms written to crawl all content looking for anyone who dares to wander into subversive pharmaceutical commentary. How weird is that? They are wasting shareholder resources just looking for this crap.

Talking about HCQ is not exactly fringe material, either. Here is a professor of epidemiology at the Yale School of Public Health – The Key to Defeating Covid-19 Already Exists. We Need to Start Using It:

As professor of epidemiology at Yale School of Public Health, I have authored over 300 peer-reviewed publications and currently hold senior positions on the editorial boards of several leading journals. I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines. As a result, tens of thousands of patients with COVID-19 are dying unnecessarily. Fortunately, the situation can be reversed easily and quickly.

I am referring, of course, to the medication hydroxychloroquine. When this inexpensive oral medication is given very early in the course of illness, before the virus has had time to multiply beyond control, it has shown to be highly effective, especially when given in combination with the antibiotics azithromycin or doxycycline and the nutritional supplement zinc.

On May 27, I published an article in the American Journal of Epidemiology (AJE) entitled, “Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis.” That article, published in the world’s leading epidemiology journal, analyzed five studies, demonstrating clear-cut and significant benefits to treated patients, plus other very large studies that showed the medication safety.

Physicians who have been using these medications in the face of widespread skepticism have been truly heroic. They have done what the science shows is best for their patients, often at great personal risk. I myself know of two doctors who have saved the lives of hundreds of patients with these medications, but are now fighting state medical boards to save their licenses and reputations. The cases against them are completely without scientific merit.

Since publication of my May 27 article, seven more studies have demonstrated similar benefit. In a lengthy follow-up letter, also published by AJE, I discuss these seven studies and renew my call for the immediate early use of hydroxychloroquine in high-risk patients. These seven studies include: an additional 400 high-risk patients treated by Dr. Vladimir Zelenko, with zero deaths; four studies totaling almost 500 high-risk patients treated in nursing homes and clinics across the U.S., with no deaths; a controlled trial of more than 700 high-risk patients in Brazil, with significantly reduced risk of hospitalization and two deaths among 334 patients treated with hydroxychloroquine; and another study of 398 matched patients in France, also with significantly reduced hospitalization risk. Since my letter was published, even more doctors have reported to me their completely successful use.

My original article in the AJE is available free online, and I encourage readers—especially physicians, nurses, physician assistants and associates, and respiratory therapists—to search the title and read it. My follow-up letter is linked there to the original paper.

Beyond these studies of individual patients, we have seen what happens in large populations when these drugs are used. These have been “natural experiments.” In the northern Brazil state of Pará, COVID-19 deaths were increasing exponentially. On April 6, the public hospital network purchased 75,000 doses of azithromycin and 90,000 doses of hydroxychloroquine. Over the next few weeks, authorities began distributing these medications to infected individuals. Even though new cases continued to occur, on May 22 the death rate started to plummet and is now about one-eighth what it was at the peak.

A reverse natural experiment happened in Switzerland. On May 27, the Swiss national government banned outpatient use of hydroxychloroquine for COVID-19. Around June 10, COVID-19 deaths increased four-fold and remained elevated. On June 11, the Swiss government revoked the ban, and on June 23 the death rate reverted to what it had been beforehand. People who die from COVID-19 live about three to five weeks from the start of symptoms, which makes the evidence of a causal relation in these experiments strong. Both episodes suggest that a combination of hydroxychloroquine and its companion medications reduces mortality and should be immediately adopted as the new standard of care in high-risk patients.

Why has hydroxychloroquine been disregarded?

First, as all know, the medication has become highly politicized. For many, it is viewed as a marker of political identity, on both sides of the political spectrum. Nobody needs me to remind them that this is not how medicine should proceed. We must judge this medication strictly on the science. When doctors graduate from medical school, they formally promise to make the health and life of the patient their first consideration, without biases of race, religion, nationality, social standing—or political affiliation. Lives must come first.

Second, the drug has not been used properly in many studies. Hydroxychloroquine has shown major success when used early in high-risk people but, as one would expect for an antiviral, much less success when used late in the disease course. Even so, it has demonstrated significant benefit in large hospital studies in Michigan and New York City when started within the first 24 to 48 hours after admission.

In fact, as inexpensive, oral and widely available medications, and a nutritional supplement, the combination of hydroxychloroquine, azithromycin or doxycycline, and zinc are well-suited for early treatment in the outpatient setting. The combination should be prescribed in high-risk patients immediately upon clinical suspicion of COVID-19 disease, without waiting for results of testing. Delays in waiting before starting the medications can reduce their efficacy.

Third, concerns have been raised by the FDA and others about risks of cardiac arrhythmia, especially when hydroxychloroquine is given in combination with azithromycin. The FDA based its comments on data in its FDA Adverse Event Reporting System. This reporting system captured up to a thousand cases of arrhythmias attributed to hydroxychloroquine use. In fact, the number is likely higher than that, since the reporting system, which requires physicians or patients to initiate contact with the FDA, appreciably undercounts drug side effects.

But what the FDA did not announce is that these adverse events were generated from tens of millions of patient uses of hydroxychloroquine for long periods of time, often for the chronic treatment of lupus or rheumatoid arthritis. Even if the true rates of arrhythmia are ten-fold higher than those reported, the harms would be minuscule compared to the mortality occurring right now in inadequately treated high-risk COVID-19 patients. This fact is proven by an Oxford University study of more than 320,000 older patients taking both hydroxychloroquine and azithromycin, who had arrhythmia excess death rates of less than 9/100,000 users, as I discuss in my May 27 paper cited above. A new paper in the American Journal of Medicine by established cardiologists around the world fully agrees with this.

In the future, I believe this misbegotten episode regarding hydroxychloroquine will be studied by sociologists of medicine as a classic example of how extra-scientific factors overrode clear-cut medical evidence. But for now, reality demands a clear, scientific eye on the evidence and where it points. For the sake of high-risk patients, for the sake of our parents and grandparents, for the sake of the unemployed, for our economy and for our polity, especially those disproportionally affected, we must start treating immediately.

You have elite medical professionals who are out there saying that there is a demonstrably safe and effective drug for treating the coronavirus – an illness that has nuked many trillions of dollars in economic value domestically and globally and destroyed public education in this country – and that IT IS CHEAP AND EASY TO COME BY, unlike most pharmaceuticals used to treat serious conditions. And somehow the cult response to that argument is for know-nothing politicians to outright ban the prescription of the medicine for treatment and for media companies to bully and silence anyone who mentions it?

What is at stake in this for them? Do they want the coronacrisis to keep going until the election? Are they doing the dirty work of pharmaceutical companies that want to shelter their multi-billion-dollar pipeline and massive payday on new treatments? Are they just stupid? (Never rule that one out.) Are they cool with people dying if it spites the evil orange man? How many old people in New York would be alive today if they were not given unnecessary, invasive, infection-spreading treatments like being put on ventilators and were instead prescribed a simple medication from the onset of their symptoms? Is that where we are now?

I used to be downright cruel to anti-vaxxers when I encountered them. And you encounter a lot of anti-vaxxers as a homeschooler, because some people choose home education to get away from public health mandates. I would call them cranks and tell them they were abusing their children. But after the coronavirus episode, I am starting to see them in a new light and I feel pretty weird about that.

Now I fully understand what it means to lose all faith in the medical establishment and to see public health initiatives as pure gaslighting. I have zero faith in the CDC at this point. I think the CDC and the Florida Department of Health should be the subjects of Department of Justice investigations. I’d like to know what personalities in government, in the corporate realm, and in academia are profiting from disinformation. I’d like to see some FOIA requests for their records and personal correspondence surrounding data releases and treatment recommendations.

I had no problem getting our daughter vaccinated. But I see homeschooling in an entirely new way after observing the pandemic response. I am thankful that our education choices mean we will not be forced by a government institution into getting poked with whatever vaccine Big Pharma cranks out in a few months’ time, with far less scrutiny than HCQ has received over decades of use, all over an illness that really isn’t much of a threat to our young family.

As a general rule, when people default to shaming, bullying, censoring, and other such tactics, I assume they are pushing a weak agenda. If you think the case against HCQ is so damn compelling, you should be able to persuade a professor at the Yale School of Public Health that it is dangerous. If you can’t, then maybe entertain the idea that you are not as smart an armchair scientist as you think you are.

And when large institutions that have approximately nothing to do with public health research start behaving like bullies over the nuances of treatment for an illness, sorry not sorry, I have some questions about where their bread is buttered.

3 thoughts on “The hydroxychloroquine drama

  1. I agree with your conclusion, but think you are over conspiracy-thinking the whole thing. Trump touted this as a possible treatment, therefore it must be opposed. It is as simple as that. It matters not if it would actually save lives. At this point there are a lot of people who will openly admit they consider getting rid of Trump more important than saving lives.

    Liked by 3 people

  2. A doctor at the family practice clinic we use at our other home in TN contracted the virus not long after HCQ was first promoted as a treatment. He is in his early 60s, I think. He prescribed himself the HCQ/Z-pack/Zinc regimen and very quickly recovered. This did not get any publicity locally but he is a good friend of a former co-worker of mine who shared the story with me. If I were to contract the disease – I am 69 – I would request that I receive that treatment immediately.

    Liked by 1 person

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