Hydroxychloroquine and the allure and perils of abandoning evidence-based science and policy in times of crisis. (SARS-CoV-2, Covid-19 pandemic)

Hydroxychloroquine and the allure and perils of abandoning evidence-based science and policy in times of crisis. (SARS-CoV-2, Covid-19 pandemic)

Abstract:

In a disaster, the coronavirus pandemic providing a ready example, cries to abandon caution and gamble on solutions can lead to spectacular success and deadly failures.

President Trump continues to tout an antibiotic and anti-viral drug called hydroxychloroquine as a potential treatment for Covid-19. More than just promoting the treatment, Trump urges its use, including prophylactic use. 

With regard to efficacy, Trump said, "It may work, it may not." Moreover, because the drug has proven relatively safe when used under other specific circumstances (e.g., treatment of malaria, lupus, rheumatoid arthritis, and other autoimmune diseases), Trump asserts, "What is there to lose?" 

At a minimum, a loss of scientific rigor and the potential to repeat some of the same mistakes made the hasty FDA approval of azidothymidine, aka AZT or Retrovir, in 1987. Like hydroxychloroquine, AZT wasn't a new compound, it was created in the 60s as chemotherapy drug. AZT proved ineffective for that purpose but was dusted off and, in desperation to stem rising HIV/AIDS deaths, tried as an anti-viral. Encouraging success from flawed trials and political pressure pushed the FDA into a rapid approval. While AZT arguably offered some benefits, and became part of the cocktail of drugs developed in the 90s to control AIDS, patients also suffered debilitating side effects, problems related to over dosage, and drug resistance.

In the current battle against SARS-CoV-2 and Covid-19 pandemic, the FDA has granted an emergency use authorization for hydroxychloroquine, and clinical use of the drug has been tried in China, Italy, and other places where critically ill patients had no other options. There is a spectrum of anecdotal evidence, from highly encouraging to "of no use" to potentially dangerous. 

I hope the president is right, but even if he is ultimately proven correct then it's not because of his scientific insight but rather prophetic fulfillment of the saying, "Even a blind squirrel occasionally finds a nut." He certainly isn't using science.

In support of using hydroxychloroquine, Trump cites a "French study" that he claims shows "spectacular" or "encouraging" results. Alas, the paper announcing the French group's findings, 'Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial' (published in the International Journal of Antimicrobial Agents (IJAA) (See Note #1) was subsequently denounced by the journal's publisher, the International Society of Antimicrobial Chemotherapy (ISAC), who said that the organization "shares the concerns regarding the above article published recently in the International Journal of Antimicrobial Agents (IJAA). The ISAC Board believes the article does not meet the Society’s expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety." (See Note #2)  more

Originally published 22 March, 2020, Updated: 10 April, 2020.

 

Last updated on 04/17/2020