The Saga of Hydroxychloroquine for COVID-19 Has Come to an End

I have written extensively on hydroxychloroquine (HQ) in my blog. Now that the interest of society has shifted towards the COVID-19 vaccines, it’s time to do a recap of the issues I addressed related to HQ and provide a final update.
 
4/25/2020
President Trump advocated HQ and one his advisers criticized Dr. Fauci for questioning its effectiveness. The French doctor Didier Raoult claimed a 99.3% success rate in treating COVID-19 patients with HQ, and accounts of patients treated with HQ experiencing dramatic recoveries (Lazarus-like coming back from the dead effects) were appearing in the news. In my post, I warmed against accepting these isolated “dramatic effects” reports as a measure of a drug effectiveness, stated that the only measure of a drug’s effectiveness is clinical trials, and explained why.
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6/19/2020
I addressed the claim made by some doctors that HQ is 100% effective against COVID-19, and I explained not only why it is highly unlikely, but also that this is a regular claim made by charlatans. I also explain that the best clinical trials conducted so far had not found evidence that HQ worked.
 
7/3/2020
I debunked the misinformation that Dr. Fauci is aligned with powerful pharmaceutical interests to hamper the adoption of HQ as a life saving drug, and that Dr. Fauci already knew HQ worked more than 15 years ago. I also addressed the issue of the articles claiming that HQ did not work and was harmful. I argued that the fact that these articles were published in medical journals and then retracted is not a conspiracy but rather indicate that science worked the way it should. I also debunked the notion that countries that had embraced the use of HQ were doing better.

7/25/2020
I decried the politization of HQ and the notion that it is “the president’s drug”, and I outlined the evidence at the time against HQ which indicated it’s not effective against COVID-19.
 
8/8/2020
I debunked in more detail the conspiracy that Fauci knew about HQ being effective, and I proceeded to explain a bold hypothesis that explains why HQ alone does not work against COVID-19.
 
8/20/2020
I debunked the notions that high doses of HQ were used in some clinical trials to make HQ fail, or that pharmaceutical companies want to eliminate HQ because it’s a cheap alternative to their expensive drugs. Since some HQ proponents were then arguing that HQ only works with zinc (the zinc hypothesis), I pointed out that this contradicted their cheering of studies where HQ allegedly worked alone (which it shouldn’t have if it only works with zinc).
 
9/12/2020
I examined the difference between doctors and scientists and debunked the notions that “doctors know best” and that “we don’t need randomized trials”. I also described the important role of the scientific establishment in science.
 
9/18/2020
I explained why observational trials cannot provide the final evidence that HQ works, and I pointed out that even the authors of the studies that the pro-HQ folk cite in favor of HQ state that randomized trials are needed.
 
10/16/2020
Despite the evidence which indicated that HQ did not work alone or with antibiotics, some HQ proponents still supported the hypothesis that HQ worked as long as you combined it with zinc. In this post I explained the evidence against HQ alone or with zinc. I also explained why it is important to remain objective and not fall in love with your hypotheses.
 
10/24/2020
In this final post, I readdressed the conspiracy theory that claimed that the clinical trials of HQ were designed to make it fail. I also examined the accusation that Dr. Fauci’s unwillingness to accept that HQ works was killing people.
 
Update
As I have mentioned before, to reach a conclusion regarding the activity of HQ on COVID-19 you need to focus on the studies that allocate patients to treatments at random (randomized studies). There are people that keep pushing the claim that HQ does work based on the total number of studies performed on the drug, which includes the observational (non-randomized) studies which are of lower quality because they are prone to bias. I searched a database for randomized studies of HQ and COVID-19, and only two of the studies I found were positive for the drug (1, 2), whereas 25 other studies were negative (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25).
 
However, whether HQ works or not cannot be established merely by counting the number of pro and con studies. Even among randomized studies, some studies are of lower quality than others. One or two high-quality studies can trump many low-quality studies. In order to evaluate the merits of studies in addressing whether HQ works for COVID-19, scientists perform analyses (studies of studies) where they assess the quality and relevance of the studies. Throughout the COVID-19 pandemic several of these analyses have been performed. I searched the database for these analyses and I found 20 of them, all negative for HQ (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20).
 
The conclusion is inescapable, hydroxychloroquine DOES NOT work for COVID-19. Period, end of the discussion. The breathtaking number of studies conducted on this drug is a testament to its politicization. The sheer amount of manpower and resources devoted to testing HQ was unjustified when a handful of studies would have sufficed. The attacks and lies hurdled against scientists including Dr. Fauci because they refused to accept that HQ works based on the available data was unethical.
 
From Mr. Trump who unwisely promoted the drug to individuals such as the epidemiologist Harvey Risch and Dr. Vladimir Zelenko or groups such as the Front-Line Doctors who all claimed the drug worked even when the best evidence indicated otherwise, this saga has been a lesson on what people should not do with science and in science. Unfortunately, these people have not learned their lesson and still claim to have been right all along.
 
Such is the complexity of the human mind.
 
Image by WHO-openaccess was cropped from a PNG file by Cantons-de-l'Est and is used here under a  Creative Commons Attribution-ShareAlike 3.0 IGO license, and was modified to include the name and formula of hydroxychloroquine.
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