Christians Should Reject the Latest Pro-Hydroxychloroquine Video

"Why do you reject randomized, double-blind, placebo-controlled trials in favor of a video touting an anecdotally based conclusion?  And, to be clear, there are many other studies from around the world demonstrating the same result that hydroxychloroquine is not an effective treatment for COVID-19." - John Ellis

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Aaron Blumer's picture

EditorAdmin

My attitude toward the hydroxystuff is more agnostic. I'm willing to say "we don't have have solid evidence that it works." I'm not ready to say "we have irrefutable evidence that it doesn't."

It does appear, at the moment, that the scales tip toward "it doesn't help," but there are apparently some studies that point the other way. Maybe one or more are well randomized, blinded, and controlled. 

This from Jim Geraghty yesterday....

If you want to make the argument for the effectiveness of hydroxychloroquine, you can point to the Henry Ford Health System study. You can point to the assessments of Harvey Risch, professor of epidemiology at Yale School of Public Health. You can point to the statements from the Association of American Physicians & Surgeons encouraging its use.

You can point to the fact that a widely-cited study declaring hydroxychloroquine dangerous, published in The Lancet, was retracted after questions about its accuracy and the expertise of those conducting the study.

If you want to make the argument for the effectiveness of hydroxychloroquine, you would probably want to avoid using a term like “cure,” because that’s more or less the terminology of every snake-oil salesman. Hydroxychloroquine is a treatment. 

I don't have time to copy all of his links over, but you can go check them out.

About ad hominem

An argument "to the man," is only a fallacy when the criticism of the man isn't relevant to the claim being countered. So, if I argue, "I'm a Bible expert, so you should believe what I say about Romans 7," the counter that "Aaron is a rank amateur" is not an ad hominem fallacy. It's a valid counter.

Likewise, if the argument is "you should believe hydroxystuff is a cure because X says so and X is a medical expert," arguing that X doesn't appear to be entirely sane is not an ad hominem fallacy. The argument is a "credibility of the source" argument, and so the counterargument is valid if it's a "non-credibility of the source" counterargument.

Just wanted to clarify that. Ad hominem has its place, and is not automatically a fallacy. In this case, if a supposed medical expert actively teaches that diseases come from demon and alien sex, it's entirely valid to say "you really need a better source," ... which is Geraghty's claim. I agree with him on this one, though I'm not sure his hydroxy studies are very strong evidence either.

Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.

John E.'s picture

So far, that I'm aware of (and I've looked) all of the studies that present a positive case for hydroxychloroquine are observational studies, including the Henry Ford one, not randomized double blind studies. Some of the earlier, more famous pro-HCQ studies have been retracted. If there are randomized double-blind, placebo-controlled studies that demonstrate HCQ's effectiveness, I would love to see them because it would behoove us all for a legitimate therapeutic to be discovered. Until then, considering we're discussing the efficacy of a drug, the epistemic weight of the randomized double blind studies that have been released far outweigh the observational studies (and there are observational studies that present a nil case for HCQ).

Also, I don't believe that the Association of American Physicians and Surgeons is a reputable organization. In the past, for example, they've promoted the conspiracy theory that vaccines cause autism. 

As far as Dr. Risch, I could share links of other epidemiologists and virologists taking him to task for his op-eds. The core of the criticisms is that he is giving far more weight to observational studies (some of which have been retracted) than to the randomized double blind, placebo-controlled studies. 

What I've found, and why I wrote this article, is that research methodology is often ignored in favor of confirmation bias for many people. 

Bert Perry's picture

If someone claims to have proven HCQ does not work, what you know is that they either don't understand how statistics are used in these studies, or they're intentionally deceiving you.  The trick is that you do not prove the null hypothesis--that HCQ does not improve outcomes--but you rather "retain" it because there is not sufficient evidence for the alternative hypothesis, that HCQ helped people.

There is also a reality that some researchers tend to design experiments specifically so that there is not a sufficient sample or test to prove an alternative hypothesis, and yes, dishonest people use those to "prove" things that are just not true.  This was very common, IMO, when federal and state governments were investigating the efficacy of "abstinence only" sex ed.  One study I looked at did not even try to put together a reasonable control, and performed no statistical tests--but concluded that abstinence based sex ed did not work based on some spectral evidence nonetheless.

Given political passions about COVID, I wouldn't be surprised to see a few such examples of chicanery in HCQ tests.  Haven't really looked through the data, but if history is a guide.

Another reality; given that there is a week or so incubation period before someone is sick enough to seek help, and then another bit of time before it's time for the hospital/ICU, there are a number of ways the drug could be prescribed, and hence a study saying "it did not generate better outcomes in this regimen" does not necessarily contradict another with different usage.

Put gently; what we would expect in a politically charged epidemic that's only been going on half a year or so.

Aspiring to be a stick in the mud.

John E.'s picture

Again, this is my concern: None of the studies that I linked to nor none of the others that I'm aware of make claims of epistemic certainty. In my article I made sure to use language like "studies demonstrated that HCQ is not an effective treatment" and "HCQ is not a miracle drug." The problem is that many conservatives (Christian and otherwise) are very quick to latch on to suspect claims and lesser research while dismissing the most robust clinical studies as contaminated by political ideology. To be honest, from my vantage point, the pro-HCQ crowd is far more driven by political ideology than the scores of virologists and researchers doing the hard and apparently thankless task of examining the claims of the observational studies. I'm not saying that's you, Bert, or that you disagree with me. It seems to me, though, that the concerns you expressed in your comment are far more valid for the pro-HCQ crowd than those who are currently skeptical of the drug's effectiveness. From what I've seen, the only ones expressing epistemic certainty about the drug's effectiveness are all pro-HCQ.

Bert Perry's picture

John, I'd argue it's on both sides--hard to tell who's worse.  Keep in mind that the biggest study to date, out of Lancet, was retracted because the authors didn't submit their data for third party peer review.  And perhaps I'm reading other journals than you, but I've heard plenty of anti-HCQ triumphalism.

Still don't know if it works, but the science is a mess.  Part of it's understandable, but my goodness...

Aspiring to be a stick in the mud.

John E.'s picture

We could go back and forth on which "side" expresses the most triumphalism or not. My concern (my reason for writing the article) is the methodological malfeasance being done by many conservatives to justify what increasingly seems to be a political issue for their "side." Simply put, I want conservative Christians to be aware of our epistemic blindspots and be careful before making dogmatic truth claims based on shoddy and, at times (like Dr. Immanuel), downright faulty research methodology. I think it's fair to say that I haven't expressed any opinions about the efficacy (or lack thereof) of HCQ apart from what legitimate research currently reveals. And I'm more than willing to discover/interact with research that suggests otherwise. That being said, I'm also not going to lay aside what I know about the differences/values between observational studies and randomized double blind studies. To that end, I do have a question: Are you aware of any randomized double blind studies that offer evidence pointing in a different direction from the studies I linked to in my article (and the 5 others I didn't link to)? If they exist, I want to know. That's a conversation worth having. And, again, I would LOVE for it to be demonstrated that HCQ is an effective treatment. That would greatly ease my concerns about my kids going back into the classroom in two weeks. 

WallyMorris's picture

I am a pastor, not a doctor, scientist, or statistician. Therefore I am not qualified to give opinions about the validity of scientific studies because I don't know. I can only give references to various studies so people can have more information. This virus seems very complex and varied in its symptoms and health consequences. The body chemistry of people also varies. Perhaps certain medicines help some people but not others. If someone wants to take a certain legal medicine to see if it helps, then why not let them?

Wally Morris

Charity Baptist Church

Huntington, IN

amomentofcharity.blogspot.com

John E.'s picture

What is the thesis of my article? I'll give you a hint: it's in the title and the final sentence of my opening paragraph. And it is the sole reason why I wrote the article. Who said anything about banning people from taking legal medicines to see if it helps them? I know I didn't. 

Bert Perry's picture

Wally, google "Thalilomide" for reasons we'd want to do some experiments to demonstrate that the side effects of a drug do not in fact exceed the likely benefits of the drug.  Or "Vioxx", which earned my grandmother a triple bypass.  Thankfully she's still doing great at 100--they found out in time--but many were not that lucky.  We have drug approvals for a very important reason.

One other thought; a good example of excessive confidence in the null hypothesis came from the World Health Organization, which stated flat out that a number of approaches "did not help" instead of saying "insufficient evidence exists".    Put gently, given the expertise of WHO, I can excuse the guys at Fox News and Breitbart for their errors far more than I can WHO.  Not that it's commendable in either case, but we ought to hold WHO to a higher standard.

(also of interest are statements of "masks do not work" early in the epidemic, when the real issue was "please save masks for first responders")

Aspiring to be a stick in the mud.

Bert Perry's picture

John, the best thing I've seen for kids going back to school came from my daughter's father in law, a pathologist at Mayo--and the upshot of what he showed us is that until age 24 or so, odds of significant problems are minimal.  Not a big consolation to the families of kids who were those rare cases of having problems, but it places the odds in perspective for parents of kids who are basically healthy.  Big risk factor outside of age is metabolic syndrome.

Aspiring to be a stick in the mud.

John E.'s picture

Bert, I've read similar studies but more studies are coming out. I haven't read it yet, but a study just released apparently concludes that kids under 5 carry a larger viral load than anyone else, hence young kids are big vectors for the spread even if they never develop symptoms (again, this is the study's conclusion - a study that I haven't read and don't have an opinion on). There are also studies here in Florida about post-COVID morbidities in children who had mild and asymptomatic cases that are not encouraging. I don't worry about mortality regarding my kids if they get it; I worry about reduced lung capacity and greater risk for organ failure later in life. I also worry about them giving it to me and my wife.

Our kids are going to a private school this year and my wife and I are mostly happy with the measures the school is putting in place to help mitigate the potential for spread. Thankfully, the school's cafeteria is outside (perk of Central Florida, and it was outside before all this) - the one place students can't wear a mask for obvious reasons.

WallyMorris's picture

John: Never said anything about banning anything, just letting people take legal medicines.

Bert: My wife has taken HCQ for many years for another problem and hasn't had any side effects.

Wally Morris

Charity Baptist Church

Huntington, IN

amomentofcharity.blogspot.com

dgszweda's picture

Does not anyone realize that the sole purpose of these "pushes" for hydroxy is to appease Trump's ego?  All doctors can read the peer reviewed studies on hydroxy today and have access to the same medical literature and studies that everyone who is touting this has access to.  All doctors can prescribe hydroxy.  So what is the push?  Consumers can't prescribe themselves hydroxy?  The FDA can't change the labeling on the drugs into the drugs go through clinical trials.  There are billions of dollars on the line here that pharma companies would love to get a hold of by running a study and proving that the drug works.  Which at this point in time they have been reluctant to do, because they can't prove it.  I don't know what the conversation around hydroxy is for?  There is no deep state here.  This is purely a private industry play, which they would love to make the money hand over fist if it was there.  We are fighting over the benefits or non-benefits, but Trump slamming his fist down, doctors touting its benefits, FDA putting it on an emergency list....  None of that changes anything from what is happening today.  It is showmanship to the consumer (who doesn't have studies or who can't prescribe) and trying to make Trump look right.  If there was really something here, everyone would be going full steam, there is too much money at stake not to.

 

John E.'s picture

Not to be rude, but I'm not sure you read my comment any better than you read my article (if you even read it). You concluded your comment by asking a question. My comment was questioning the validity of your question as it relates to my argument. I mean, this is a comment thread under an article with a very clear thesis, right? 

Don Johnson's picture

I don't know about the drug (can't even spell it or pronounce it). I think it is probably safe is used according to prior protocols, but I don't know if it actually does anything for Covid or not.

What I wonder is, what do you think of Twitter and Facebook burying the video? Does this not give it that much more credence among the true believers? "They're out to get us" and all that. Perhaps there could be a better strategy?

Maranatha!
Don Johnson
Jer 33.3

John E.'s picture

Before I wrote the article, I didn't know how to spell it either. After having written it over and over, the spelling is drilled into my brain. Still can't pronounce it, though.

I can see the arguments for both hiding it and not hiding it.  Honestly, in my opinion, nothing that anyone does, doesn't do, or says will sway the true believers of HCQ - those who believe it's a miracle cure. I guess, if we want to argue that there is no reason to stoke the fire of "they're out to get us," then, sure. My concern with the video and the touting of it by Christians is more epistemological than anything. So, in that sense, I lean in the direction of hide it. 

dgszweda's picture

Don Johnson wrote:

What I wonder is, what do you think of Twitter and Facebook burying the video? Does this not give it that much more credence among the true believers? "They're out to get us" and all that. Perhaps there could be a better strategy?

My opinion is that they should not censor it.  There is nothing really in it to be worthy of censorship.  Put it out there and let the experts comment.  In the end it won't change anything.  Why?  The hydroxy obsession taking place is very interesting.  I have spent time in college and beyond studying how conspiracy theories are structured and gain traction.  This follows along the same vane.  Regardless of whether hydroxy is interesting or not, there are a number of drugs in the same exact boat that shows interest (i.e. ritonavir).  The discussion around those who are pushing hydroxy has very little to do with its perceived efficacy.  They are pushing a narrative.  That narrative is that 1) we should reopen, 2) the virus is not that bad, 3) vaccine makers and or drug companies are the ones hiding the benefits of hydroxy, and 4) there is a concerted effort/deep state to discredit Trump, and the media is one of the key drivers for this.  The reason why this has gotten traction is because of the promotion of the president.  If the president had actively promoted any number of other drugs, those would have been the ones that took off.  There is absolutely nothing unique here in the drug itself.  Yes some studies have shown success, but there are similiar type of studies for other types of drugs.  The larger population, double blind, randomized studies do not show the benefit with hydroxy or any other drug.  None of the data is hidden or being supressed around this and it would be impossible for the media to supress 100,000 doctors and billion dollar pharma companies to abandon what is good for patients and the financial coffers to hid behind the media.  It is a very interesting phenomenon, and it is being played out across a number of other areas.

What many don't realize is that massive amount of money and coordination from far right groups that are pushing this narrative.  Most people are sitting here taking up sides around a certain medicine looking for an expert on one side or the other, totally oblivious that this entire thing has nothing to do with medicine.  Many of the doctors on the front step of the Supreme Court had no idea who was funding their exercise.  The Tea Party Patriots funded it, along with a number of other GOP Super Pacs and promoted on Breitbart.  There is a broader social media push as well.  Things such as the Second Opinion Project which was setup to push the narrative across numerous channels.  Watching this entire thing playout is very interesting.

 

fsansone's picture

A couple of quick comments regarding HCQ.

1.  The fact that it has demonized because Trump promoted it is a shame.  I had become aware of the French study before Trump mentioned it and was hopeful that it might be an effective treatment.  Once Trump mentioned it, it became (like seemingly everything else in this current age) a political hot button with the usual Anti-Trump side ripping it apart and the Pro-Trump side thinking it was a cure-all.  My opinion has been that we should continue to test and find out and not worry about the politics of the issue - but, alas, that is being a pollyanna in this day and age.  I sort-of wish President Trump had not mentioned it, since that might have helped it not to become a political issue rather than a medical issue.  

2.  Much of the criticisms of the Pro-HCQ studies deal with many of the studies not being "double-blind studies."  In the early French study, the authors of the study answered that objection, explaining that the effectiveness of the treatment compelled them to give it to the patients who were not originally scheduled to receive it because failing to do so would have been to withhold from them a treatment that was having such a positive impact in the others - and that the doctors felt this would be a violation of their medical ethics to withhold effective treatments from those who needed it.  

3.  A lot of people have taken this medication for years with a knowable range of side-effects.  Some of the anti-HCQ hype has had some folks fear taking medication that they have already taken for Lupus and other conditions.  

4.  I will admit a bias in hoping that this is an effective treatment - or really that there is any kind of effective treatment to be had.  

5.  I find this article at Real Clear Politics a reasonable counter-point:  https://www.realclearpolitics.com/articles/2020/08/04/an_effective_covid...

6.  It seems that many of the anecdotal stories from Doctors who seem to be actually using HCQ with good effect include use of Zinc with the HCQ.  I am not sure why the studies seem to leave this part out.  

 

A couple of other comments and observations.

I have not watched the video, so my comments are not in defense of the video.  

I read the studies that John posted and I wasn't really impressed, for the following reasons.

In the New England study a few things stand out.

1.  The goal was seeing about its use as a prophylaxis, my concern has been about using it as a treatment.  (I know the President was at one time said to be using it that way, but most doctors I have seen that are supporting HCQ seem more concerned with its use as treatment, not as a prophylaxis.)

2.  It is interesting that they could not go as far as originally planned since the actual mortality and hospitalizations of both groups (HCQ and placebo) was so low that there was not a significant enough group who were hospitalized or died to be able to reach any conclusions on that front.

In regards to the article on the Annals of Internal Medicine site

1.  It similarly had to adjust due to the relative low number of participants being as severely effected as needed for the full goal of the study.  (I think this is actually a good thing for people, although not for the study.)

the study wrote:
Among the enrolled participants, the incidence of hospitalization was only 3% and incidence of death only 0.4%, making the planned analysis of the ordinal end point futile

2.  The hospitalizations were half as many for the HCQ group as the Placebo group, which would be significant if there had been enough in both groups to really count (there were only 4 in the 203 who were in the HCQ group and 8 of the 194 who were in the placebo group).  If this were to hold overall, that would be significant, but with only 3% of the sample group actually needing hospitalization, a much larger sample would be needed to see if this difference would hold up.

I find it encouraging that these two studies used people who were exposed and expected to have COVID and yet only 12 of 397 in one study and 2 of 821 in the other study actually had to be hospitalized with the disease.  

I don't think we know enough about its effectiveness. but I do think it continues to warrant attention (as do other treatments.)  Since many of the anti-HCQ studies seem to have involved uses that the anecdotal stories are not advocating (e.g. using after symptoms are fairly advanced - which is what the third study John linked to seemed to do - it also seemed to deal with a much higher dosage than the other studies I have seen), I would definitely not use those studies to make conclusive statements against its efficacy in the suggested usage (early in the process, combined with zinc and possible Zpack, etc.).  

Just my thoughts.

Aaron Blumer's picture

EditorAdmin

It's too soon to be confident about HCQ either way.

As for Trump's role its demonization...   How to put it. Nearly everything Trump does is intensely personal, combative, and political. So if he wanted HCQ to get a fair shake, he should kept silent... or maybe should have denounced it vehemently on Twitter. Backlash is what he has trained everyone to do at this point (they would have done it without his training, but he has fed and grown that problem nearly every day he's been in office.)

Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.

pvawter's picture

Apparently, not every RCT is negative with respect to the effects of HCQ on Covid-19. 

https://arxiv.org/abs/2007.09477

"We conclude their randomized, double-blind, placebo-controlled trial presents statistical evidence, at 99% confidence level, that the treatment of Covid-19 patients with hydroxychloroquine is effective in reducing the appearance of symptoms if used before or right after exposure to the virus."

RajeshG's picture

pvawter wrote:

Apparently, not every RCT is negative with respect to the effects of HCQ on Covid-19. 

https://arxiv.org/abs/2007.09477

"We conclude their randomized, double-blind, placebo-controlled trial presents statistical evidence, at 99% confidence level, that the treatment of Covid-19 patients with hydroxychloroquine is effective in reducing the appearance of symptoms if used before or right after exposure to the virus."

Through skimming through the PDF of this article, I found, as best as I can tell, that this article is not about some new clinical study that showed the efficacy of HCQ. It is a study that shows that certain aspects of how the data in another study that found no value were analyzed in a manner that did not provide a right understanding of the data. When the data was analyzed differently, the results of that other study, which was a clinical study, do show that HCQ was effective when given "before or right after exposure to the virus."

A key finding of this new statistical analysis: "Our results show that the time elapsed between infection and the beginning of treatment is crucial for the efficacy of hydroxychloroquine as a treatment to Covid-19" (Last sentence of the abstract in the PDF).