Comment by firasd | Hacker News Reader

Comment by firasd | Hacker News Reader

When the Covid crisis is over, one of the strangest sub- plots will have been the fracas around Hydroxychloroquine. Starting from medical practitioners worldwide adopting its usage in a ‘cargo cult’ way, mimicking what other doctors were doing, to Raoult’s low- quality study. Then people in Silicon Valley (notably Elon Musk) picking up the idea. Followed by the explosion in the political sphere, from Trump pushing it at the White House podium, to Indian PM Modi reversing an HCQ export ban for Trump, to French PM Macron talking it up.

All the while HCQ remained unproven for Covid use, while people trying it got hurt by cardiac side- effects (and one couple in a prominent incident mistakenly took different chemicals with a similar name), and patients with other conditions ran out of HCQ due to shortages.

Maybe HCQ will be part of the standard of care for Covid- 19 in the future, but it’s seeming less and less likely. Meanwhile it’s definitely not a miracle cure, so the frenzied advocacy and adoption of this medicine will turn out to have been a bizarre story.

(I wrote this up here https://twitter.com/firasd/status/1250125344469708801)

The recent reports about low benefits of HCQ didn't stop Raoult from appearing in a video about the state of HCQ and covid-19 in his clinic. Sadly he seems to be yet again using very wide statistics to justify his views (covid is of no importance compared to yearly stats [0]) and digress into political attacks (his past interactions with pharma labs that weren't conflict of interests).

I still can't say if he's a low hanging troll [1] or if he's just so far above the pack that everybody else is braining wrong. That's also his motto... he likes to discuss disruption and paradigm shift in his classes and talks about how every past paradigm was considered gold standard and only people breaking the mold advanced the state of the art.

[0] unsurprisingly Musk is also very fond of wide stats to justify his AutoPilot ~feature

[1] his lab specializes in repurposing well studied compounds for new diseases.. seems like leveraging past efforts to get success (if I go full paranoia :)

Even pre-covid, Raoult had a reputation for pumping out hundreds of really poor quality studies and making controversial public claims. It's a shame he's the one that's caught the attention of the general public, there's lots of good work going on with other potential treatments, but suddenly my social media is filled with armchair pharmacologists arguing about this one drug.

That's the issue, it seems that to conclude on its case would mean discrediting the whole publication structure (system too easy to rig by flooding)

I wish medias would do broader panels to discuss varied POVs rather than one ~icon.

My understanding is that fish tank chloroquine phosphate is the exact same molecule as the pharmaceutical. You shouldn’t take it because it doesn’t have pharmaceutical quality standards and is very tricky to dose.

There was a news item about someone who took it and was seriously poisoned. People predictably blamed the President.

Politically, yes, there was/is a cargo cult. Both for those convinced it's a cure, and the anti-cargo-cult opposing party convinced it's somewhere between useless and actively harmful.

From a medical practice standpoint, you have a widely-available drug with well-known side effects that can be administered in a medical setting with low risk, and potential life-saving upside. When the research is early but potentially promising, it's not irrational to administer in cases where the side effects should be well-tolerated, even if later research shows no or low benefit.

The problem arises from self-administration without medical supervision, or with inadequate medical supervision.

The problem with 'low risk / high upside' is that it can apply to anything. We can try lemonade since it has low risk and high upside. But at some point we have to start wondering if we should all be obsessed with lemonade right?

Even when doctors were using HCQ before the politicians and random outsiders picked up on it, there were other drugs in the mix that they were also considering (Lopinavir, Remdesivir, etc). Incidentally Remdesivir trials have also come out lately seeming pretty weak. But there is still nowhere near the level of frenzy around Remdesivir as there has been around HCQ to the extent of advocacy at White House press briefings, international diplomatic incidents... it's beginning to seem like a very strange mass hallucination.

If there is a serious suggestion that lemonade works we should try it in medical settings. So far the only suggestions come from those who point to alternate theories without any science - even a case study. If you get a doctor to try it and it works ill be more interested. Until then it is quacks and I'm not.

Remdesivir is very difficult and expensive to synthesize, and it’s patented by Gilead. HCQ is dirt cheap and generic. Of course we should be testing anything that shows enough promise and has a well understood safety profile, but it’s obvious why the cheap generic drug working would be better.

> anti-cargo-cult opposing party convinced it's somewhere between useless and actively harmful.

Can you name some prominent members of this cult and their statements that match this framing? Serious question. I don't think anyone really matches that description. Pretty much everyone horrified at the cloroquine boosterism was horrified because it was irresponsible and dangerous, not because they had strong feelings about the drug itself.

A handful of friends/acquaintances on fb - so, no, sorry. It's clear they're less informed than most, and I've certainly seen plenty of more appropriate responses along the lines of what you describe.

To clarify a bit: it's certainly not the position of the opposing party as a whole, but those I saw who were vehemently opposed to it were ideologically motivated.

So... you consider a handful of people in your social media circle rhetorically equivalent to an "opposing party" made up of most of the major media figures on the biggest news channel on TV and the president of the United States?

No. My original comment wasn't worded well, sorry. See my clarification above.

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