Hydroxychloroquine has been a topic of intense focus since we first started seeing cases of COVID-19. At the beginning of the pandemic, I was constantly texting with friends and reading articles about this new disease caused by SARS-CoV-2 and what everyone was seeing. We were all talking about our clinical experience with COVID, what works and what doesn’t.
What symptoms do people come in with? When do you start medications? What complications do they have? What do people die from? What medications work? How do you measure their effects? When do you intubate? What is your hospital doing? What protocols are you using?
Hydroxychloroquine was brought up during basically every text exchange, Twitter thread, and journal article. I’ve spent more time thinking, talking, and reading about this medication than I ever imagined I would.
Our first impressions of hydroxychloroquine
At first, we thought hydroxychloroquine was going to be a mainstay of the treatment for COVID.
It was part of the protocols at leading medical centers around the country. World “experts” thought it provided immunomodulatory effects that might reduce severity of COVID. Some hospitals were recommending their frontline doctors take it for prophylaxis.
We were giving it to literally every patient in the hospital who had confirmed COVID.
I wrote a newsletter on this very early in the pandemic. The general gist of my observations back in the beginning of April was that if hydroxychloroquine really was a miracle drug, the effect would be so obvious that there wouldn’t be so much confusion regarding its effectiveness, but we needed to wait for randomized trials to determine its effect.
I figured since hydroxychloroquine is in the news again as a potential COVID lifesaver because of a newly published study that this is a topic we needed to revisit.
After all, we’ve spent almost $90 million of taxpayer money (90 million dollars!) trying to prove that it works in COVID.
Tell me more about this new study
A new paper out of Henry Ford Medical Center in Detroit found that use of hydroxychloroquine was associated with a reduction in death from COVID. The Henry Ford Health System put out a press release with language that makes it seems like hydroxychloroquine is now the game-changing COVID miracle we’ve all been hoping for.
From the press release:
Treatment with hydroxychloroquine cut the death rate significantly in sick patients hospitalized with COVID-19 – and without heart-related side-effects. The study found 13% of those treated with hydroxychloroquine alone died compared to 26.4% not treated with hydroxychloroquine.
The CEO of the Henry Ford Health System spoke without ambiguity:
“Our analysis shows that using hydroxychloroquine helped saves lives,” said neurosurgeon Dr. Steven Kalkanis, CEO, Henry Ford Medical Group and Senior Vice President and Chief Academic Officer of Henry Ford Health System. “As doctors and scientists, we look to the data for insight. And the data here is clear that there was benefit to using the drug as a treatment for sick, hospitalized patients.”
The news from this study was reported by every major media outlet. It made the President’s Twitter feed. This report prompted Peter Navarro to recommend that the FDA reconsider its stance on hydroxychloroquine so that we could expand its use.
If you read the press release, it sounds like great news. After all, what’s not to like about reducing the chance of dying by half?
Unfortunately, these proclamations are simply too good to be true, and both the doctors who made them and the journalists who reported them should know better.
What’s the real story?
There are quite a few ways that the press release is misleading. If you read the actual study, you quickly realize that the authors completely misrepresent the conclusions that can actually be drawn from this research. Let’s take a look the 3 biggest flaws in the logic describing hydroxychloroquine as a life saving drug:
This is an observational study, not a randomized trial. This means that we can only find a correlation, which - by definition - doesn’t tell us anything about cause and effect.
The patients who received hydroxychloroquine were significantly younger than the patients who didn’t. We know that age is the biggest risk factor for death from COVID. So the age gap alone could explain the findings.
The patients who received hydroxychloroquine were about twice as likely to receive steroids as part of their treatment. We know from the RECOVERY randomized trial that steroids provide a life saving benefit in severe COVID, which provides another plausible explanation for the differences between groups.
The bottom line is that this new study provides literally zero new information to us. It’s a relatively small observational study with significant confounders that can explain the results without attributing any of the effect to hydroxychloroquine.
Data from an arm of the RECOVERY trial showed no benefit from treatment with hydroxychloroquine in a randomized, controlled trial. It’s a medication that has known side effects without clear benefit. I see essentially zero role for its use as a standard COVID treatment.
Why does this nonsense happen?
There’s a symbiotic relationship between researchers who want to overhype the findings of their unimportant research and a group of credulous reporters and media outlets who profit from the traffic generated from an overhyped story.
This is the same kind of nonsense we see constantly with nutrition research where an essentially meaningless study is hyped as a game changer for the benefit of some clicks. Think about every story you’ve see in the newspaper about chocolate preventing heart attacks or coffee making you live longer.
It’s a real problem that undermines public trust in scientific research.
The reporters who write these articles should know better, and the scientists who perform this research shouldn’t be so willing to exaggerate the significance of their findings.
PS: If you’re enjoying my newsletter, please sign up to receive email updates. I would also be appreciative of you sharing on social media and encouraging others to sign up.