There are some pieces that you never really expect to write. Whether it’s geophagy, or people literally eating dirt, drinking blood to prevent aging, or just the ongoing saga about whether meat is deadly or perfectly curative for health, there are a lot of topics that I’ve covered over the years that are, well, a bit strange.
And yet, in some ways this feels like the strangest. If you’d told me in 2019 that we’d be debating the benefits of an anti-malarial medication for pandemic disease despite a mountain of evidence that it didn’t work, I’d probably have giggled nervously and walked away.
Which brings us to hydroxychloroquine (HCQ). One of the strangest stories that I have ever written.
It probably doesn’t work for coronavirus. We knew that some time ago. But somehow, it’s still a debate to be had.
Back in the heady days of early 2020, before we had all locked down and politicized medications, HCQ was just another drug that people thought might be useful for COVID-19. There were dozens, even hundreds, of proposed treatments, so one more drug didn’t seem like a big deal — we could test it, see if it worked, and then use or discard it just like all the others.
And we did do those tests. Massive, well-conducted studies, with appropriate scientific controls that looked at the question of whether HCQ helped with coronavirus. The results are in, so what did they find?
Hydroxychloroquine probably doesn’t work for coronavirus. It doesn’t help people who have severe illness. It doesn’t prevent illness in high-risk groups. There’s no evidence it benefits people with mild disease either, even in combination with azithromycin. There’s still a bit of a question mark over whether HCQ might reduce the risk of getting the disease for people who are low-risk, but the initial results are not looking good.
Now, you can take those results as you like, but it’s worth noting that these are really quite impressive trials. Running a properly controlled randomized study of over a thousand people in less than six months is an immensely impressive work, and the findings are both stark and uncompromising: HCQ probably doesn’t benefit COVID-19, and may be harmful.
As certain right-wing pundits like to say, facts don’t care about your feelings.
Thing is, the facts aren’t going to stop this debate. Our well-developed hierarchy of evidence, going from expert opinion (mostly useless) to controlled, randomized research (very useful), means very little in the face of the HCQ discussion.
Because, you see, it’s not really about the science.
If it was about the science, we’d have discarded HCQ months ago along with the other medications that have failed to show a benefit (anyone remember ritonavir?). Instead, we have people dividing their opinions over political lines — if you are right-wing, in certain places in the world, you support HCQ.
This is, to say the least, a very unusual state of affairs. It’s rare that you have a tug-of-war between political parties about whether a drug works.
The problem, to a great degree, appears to come back to whether government interventions are necessary to combat COVID-19. People who are against lockdowns and similar interventions point to HCQ and say “look, no need for the government to do anything, we have this miracle cure right here!”. The fact that there are no miracle cures, and that HCQ has very little good evidence recommending it, could never get in the way of what is essentially an ideological argument.
Which is why, in the comments, you’d expect to see a bunch of people calling me left-wing, a socialist, demon spawn etc. Not because I’m wrong, but because the drug has taken on a life outside of the questions about whether it works or not. People will probably accuse me of being in the pockets of pharmaceutical companies because HCQ is cheap (and thus I MUST be getting paid to write this), ignoring the fact that I happily accept the similarly good evidence showing that dexamethasone can prevent death in severe cases of COVID-19 and it’s cheap as chips.
Honestly, it’s all a bit tiresome.
So, no, hydroxychloroquine probably doesn’t work for COVID-19. Of course, it’s possible that new evidence will come to light disproving the studies done so far, but at this point it really is quite unlikely.
We can hope that the debate will finally be laid to rest, but since it’s no longer about facts it’s probably never going to happen.