July 2020

Chloroquine Controversy

I posted this link on FB two days ago without comment. In the light of efforts to suppress and discredit the testimony of a group of intelligent and courageous physicians. I’m reposting it here with comment.

Apart from the very odd, and for me worrying, fact that the video was banned from YouTube, the way that the media has reacted to these ‘frontline doctors’ talking about hydroxychloroquine is quite disturbing.

Almost all of the criticism has focused on Dr Stella Immanuel. Dr Immanuel is admittedly quite shouty in the video and, in her other role as a pastor, she apparently has odd metaphysical beliefs, but I’ve noticed that the critics do not challenge her claims to have treated 350 covid-19 patients who have all recovered. This is the first thing I would investigate if I were an investigative reporter. I might of course suppose that the other doctors with her knew something about her work and claims but I would talk to them. These other doctors are, however, studiously ignored. I have seen an article on the video referring to Dr Immanuel and a group of ‘people in lab coats’. Those who introduce themselves do so as physicians. Dr Immanuel’s work is cited but the argument that hydroxychloroquine should be considered and made available as a treatment is endorsed and proposed by the other doctors.

Pay special attention to what Dr Joe Latipo (I don’t know if this is the correct spelling) says from 31:00 to 36:00 minutes into the video. This is exactly what journalists should be saying. I doubt that he will be widely quoted and I doubt that this video will be widely seen. I may extract and post the Lapito segment for discussion separately since what he says about bringing ‘more light to the conversation about how we manage Covid-19’ coincides with my own interest in having more reasoned conversations about the pandemic and more generally.

Lapito notes that while there are moral issues on which there should be a singular voice, “Covid-19 is not a moral issue it is a complex, challenging issue that we benefit from having multiple perspectives on.” Lapito notes that there have been both randomised control trials that suggest that hydroxychloroquine is not effective against Covid-19 and observational studies that suggest that it is effective. He argues that given that there is evidence for both positions and given that the drug has been used safely for decades limiting its use as a treatment option makes no sense. “All of a sudden” he says “it’s been elevated to being this poisonous drug.”

Worth highlighting too is the segment from 38:30 to 39:40 where one of the doctors is talking to a particularly dense reporter about the relationship between zinc levels and covid-19. Apart from reminding me of the widespread failure of reporters to ask decent questions this reminds me that we should be talking about other prophylactic measures besides distancing, wearing masks and washing hands, such as taking zinc and other mineral/vitamin supplements.

I cannot of course comment on the efficacy of hydroxychloroquine but here’s a link to a 2003 Lancet article that is worth reading. The article begins

“.. the tolerability, low cost, and immunomodulatory properties of chloroquine/hydroxychloroquine are associated with biochemical effects that suggest a potential use in viral infections, some of whose symptoms may result from the inflammatory response.2, 3 We raise the question of whether this old drug whose parent compound, quinine, was isolated in the late 19th century from the bark of the tropical cinchona tree, may experience a revival in the clinical management of viral diseases of the era of globalisation.”

The article goes into the mechanisms through which chloroquine acts against viruses similar to Covid-19 and concludes

“Due to its broad spectrum of antiviral activity as well as to its suppressive effects on the production/release of TNFα and interleukin 6, chloroquine/hydroxychloroquine may also find a place in the treatment of other viral infections characterized by symptoms associated with inflammatory processes and/or immune-hyperactivation.”

With regard to the efficacy and safety of hydroxychloroquinine (HCQ) in relation to covid-19 there have been claims that studies have shown it to be ineffective and dangerous. It appears that the most authoritative of these studies was flawed or even faked. The following is from a June 2020 Guardian article:

The Lancet paper that halted global trials of hydroxychloroquine for Covid-19 because of fears of increased deaths has been retracted after a Guardian investigation found inconsistencies in the data.

The Lancet study had a dramatic impact on attempts to find out whether the antimalarial drug hydroxychloroquine, and its older version, chloroquine, could help treat patients with Covid-19. The US president, Donald Trump was among those who backed the drug before any high-quality trial evidence had been published.

The World Health Organization and several countries suspended randomised controlled trials that were set up to find an answer. Those trials have now been restarted. Many scientists were angry that they had been stopped on the basis of a trial that was observational and not a “gold standard” RCT.

The Guardian 4 June 2020

There are serious questions to be asked about HCQ and more generally our responses to the covid-19 crisis.

1. Does Hydroxychloroquine work?
2. Why has there been an effort to suppress use of HCQ?
3. Why has there been an effort to suppress discussion of HCQ?
4. Why is there not a discussion about the efficacy and cost/benefit profiles of all prophylactic measures with regard to Corvid-19 including masks, gloves, sanitisers, handwashing, lockdowns, social distancing, exercise, nutritional supplements and common medications such as asprin?

These questions have not be settled and laughing at the eccentricities Donald Trump or Stella Immanuel will not settle them.