Hydroxychloroquine: “Good Science” Challenges Politicized Science

Hydroxychloroquine (HCQ), for over 60 years a familiar antimalarial drug, has fast become one of the most popular subjects in daily news surrounding the COVID-19 virus pandemic  allegedly caused by Chinese Communist mismanagement of a lab in Wuhan, China.  Like any drug, the safety and efficacy of HCQ as a treatment for a new disease, ought to be thoroughly investigated.  However, in spite of numerous favorable reports of the life-saving benefit of doctor-prescribed HCQ, many influential people including Dr. Anthony Fauci continue to oppose its use.  Are there legitimate reasons for this opposition to a potentially life-saving drug?   Or are we about to see just how many lives will be lost simply because “good science” is being ignored or silenced by selfish political and economic agendas? 

So-called “good science” has been a frequent subject of my blog writing in Oikonomia (Greek = “household management; or, stewardship”).  To me, “good science” is an inquiry into the workings of the “household of creation” by those who recognize the necessity of and abide by a faith-based ethical foundation for their pursuit of truth [See “The Conscience of Science: Part 1 Ethics & Accountability.”]  A faith-based ethic enables the scientist to see that his or her pursuit of truth is good stewardship of his or her God-given intellectual gifts.  Scientists who view their science as a stewardship are more likely to contribute in ways that promote the flourishing of God’s creation.  In so doing, they bring benefit to all mankind.  Above all, “good science” ought to be guided by honesty in its inquiry and in reporting of conclusions.

We can only hope that current debate over the safety and efficacy of hydroxychloroquine (HCQ) will be governed by “good science” and later remembered by the thousands of lives it saved.  Therefore, I am encouraged by an article authored by Dr. Harvey Risch, a Yale epidemiologist, published May 27 in the Journal of Epidemiology.  In it, Dr. Risch refutes an earlier article published in The Lancet which had caused the World Health Organization to halt trials of HCQ as a treatment for COVID-19 infections.  Dr. Risch’s critique is a classic lesson in careful scientific analysis of published results.  It also illustrates the importance of peer review in verifying scientific methodology and correct application of results.  I encourage you to read the article.

In order to provide context for this stage of the COVID-19 pandemic, Dr. Risch estimates that over 1.6 million Americans have been infected and up to 10 to 50-fold larger numbers of people carry antibodies to the virus.  In spite of “flattening the curve” through mask-wearing, social distancing, etc., Dr. Risch believes that over time

…very large numbers of people in the US may eventually get the infection.  The great majority of infected people are at low risk for progression or will manifest the infection asymptomatically. For the rest, outpatient treatment is required that prevents disease progression and hospitalization.  Exposures will occur as isolation policies are lifted and people begin to mix, even with various degrees of public isolation such as mask usage and physical separation still in place.

Dr. Risch also recognizes that, while we are averaging an estimated 10,000 COVID-19 deaths per week in the US, we are facing a greater risk of deaths due to policies that have created an unsustainable economic and social condition with over 36 million Americans out of work and disruptions in many essential services necessary to maintain our physical, emotional, and spiritual well-being.  He concludes: “We are rapidly reaching a breaking point in the ability to maintain the status quo; states have begun the process of lifting their restrictions, and we thus need to evaluate what evidence we do have for promising outpatient treatments.” 

Dr. Risch’s COVID-19 treatment recommendation may be summarized as follows (emphasis mine):

… the key to returning society toward normal functioning and to preventing huge loss of life, especially among older individuals, people with comorbidities, African Americans and Hispanics and Latinos, is a safe, effective and proactive outpatient treatment that prevents hospitalization in the first place.

Based on Dr. Risch’s analysis of the results of numerous treatments in which COVID-19 patients were given HCQ in combination with the antibiotic azithromycin (i.e. HCQ+AZ), his recommendation is as follows (emphasis mine):

HCQ+AZ has been directly studied in actual early high-risk outpatient use with all of its temporal considerations and found empirically to have sufficient epidemiologic evidence for its effective and safe employment that way, and that requiring delay of such general use until availability of additional RCT (randomized controlled trial) evidence is untenable because of the ongoing and projected continuing mortality. No studies of Covid-19 outpatient HCQ+AZ use have shown higher mortality with such use than without, cardiac arrhythmias included, thus there is no empirical downside to this combined medication use.

The strong support for the use of HCQ+AZ from Dr. Risch was accompanied by two other endorsements of its therapeutic value.  Last week, President Trump announced that he has been using a prescription of HCQ, demonstrating that he is willing to put his health on the line to support his belief in the safety and efficacy of HCQ.  Then, this week, Breitbart reported that HCQ will be administered by Britain’s National Health Service (NHS) to as many as 10,000 health workers representing up to 20 hospitals as part of a clinical trial.

In conclusion, the debate continues between those who favor and those who oppose the use of hydroxychloroquine plus azithromycin (HCQ+AZ) for early treatment of high-risk COVID-19 patients.  However, the May 27 publication of Dr. Harvey Risch’s thorough analysis as summarized here ought to make the prescription of these drugs the centerpiece of our COVID-19 treatment strategy.  

It remains to be seen which voices will have the most influence on policy makers and medical health professionals--the voices of "good science" or the voices of those with political agendas that seem to care little about either “following the science” or protecting individual lives.   Meanwhile, I am siding with the voice of “good science” and can only hope HCQ+AZ will be available to me in the event that I am infected with COVID-19 and require medical intervention.