
I know as little about biology and medicine as the typical public health expert knows about economics and the scientific study of society. I don’t know if hydroxychloroquine is effective against Covid-19 or under which conditions. However, I believe I know something about, or I have the analytical tools to understand, a social system where politicians or public health pontiffs decide what is good or not for individuals and force it upon them.
Frequent readings about Covid-19 and a cursory perusal of recent articles in medical journals on the efficacy of hydroxychloroquine led me to believe either that the drug was detrimental or else that it had no beneficial effect. My opinion was not moved by the crowd pushing the drug, from Peter Navarro and Donald Trump to Stella Immanuel, a Texas doctor who also thinks that sex with demons in dreams causes some gynecological diseases.
Even if I lack experience in sex with demons (like, I suppose, most of my readers), I replied to a Facebook friend who did not seem to think that Immanuel is a charlatan:
I respectfully suggest that you should try to recognize a wacko when you see one.
I would add that it is difficult to believe anything from somebody who thinks that “trade wars are good, and easy to win” (a field that I know a bit) when he declares that hydroxychloroquine can cure Covid-19. Quickly recognizing a charlatan when you see one allows you to economize on information, a costly resource. It is not impossible, of course, that a given wacko be right per mere happenstance.
Then, economics professor Steve Ambler (Université du Québec à Montréal) brought my attention to a Newsweek article (“The Key to Defeating COVID-19 Already Exists. We Need to Start Using It,” Newsweek, July 23, 2020) where a respected professor of epidemiology at Yale University, Harvey Risch, summarizes the results of the research he published in a major epidemiology journal. He claims rather persuasively that the administration of hydroxychloroquine, together with other drugs, has shown its efficacy when administered early in the treatment of Covid-19 (as opposed to later phases of the disease as reported in other studies).
Whatever the results of the scientific debate turn out to be, Professor Risch’s study is useful for at least two reasons related to economics. First, it confirms the main advantage of free speech. It allows mainstream science and whatever else we know, or think we know, to be challenged. Knowledge that survives free-speech challenges can be given the benefit of the doubt, as John Stuart Mill argued in immortal terms (On Liberty, 1859):
If even the Newtonian philosophy were not permitted to be questioned, mankind could not feel as complete assurance of its truth as they now do. The beliefs which we have most warrant for, have no safeguard to rest on, but a standing invitation to the whole world to prove them unfounded. If the challenge is not accepted, or is accepted and the attempt fails, we are far enough from certainty still; but we have done the best that the existing state of human reason admits of. … This is the amount of certainty attainable by a fallible being, and this the sole way of attaining it.
In the same vein, I wish the White House would now recognize that the “enemy of the people”—in this case, Newsweek—is helping a minority idea that it itself promotes to receive a wide exposure from the pen of a credible scientist.
Second, Risch’s contrarian claim also helps make an important distinction, on which he himself does not pronounce and which is generally anathema to the public health movement. Whatever “the science” says, it should be left to each individual adult to make his own choices and trade-offs between different benefits and costs and risks as he evaluates them. This applies to which medication and treatment to choose or not to choose. Such freedom, if it were really implemented, might lead to (more) great personal tragedies in the case of individuals who would make these choices without consulting people who know how to think about medical consequences—like medical doctors. But then, tyranny also brings a lot of personal tragedies. Historically, there is no doubt that tyranny maimed and killed many more people than individual medical choice. And in a system of free choice, perhaps individuals would learn or re-learn how to be responsible for their own welfare.
READER COMMENTS
William Shack
Jul 30 2020 at 11:05pm
See the discussion of Risch’s work at:
https://sciencebasedmedicine.org/hydroxychloroquine-to-treat-covid-19-evidence-cant-seem-to-kill-it/
Pierre Lemieux
Jul 31 2020 at 3:47pm
Thanks for posting this link. Interesting and ferocious. Gorski looks to me like the typical public health expert, who knows “the science” and is happy to impose it on others good and hard. Wackoism is a matter of degree!
Dylan
Jul 31 2020 at 4:33pm
I agree that his style is a bit off-putting, but if you make it down a bit you will get to what I think is pretty compelling evidence.
Salem
Jul 31 2020 at 4:32am
I think it’s very dangerous to think there’s a general “wacko” factor. There are plenty of people who have done brilliant work in one domain, while having outlandish beliefs in others. It’s not mere happenstance, it’s the flipside of genuine expertise being narrow.
I try and think of this in terms of bounded rationality, and incentives. Are confronted with direct feedback? Are we incentivised to hold true beliefs? If yes to both, then we probably believe sensible things in that area. E.g. a chemist’s beliefs about his experimental results probably track the truth. But if no to both, then belief is probably more a question of identity or affiliation. There’s no reason to think the same chemist’s views are remotely truth-tracking in realms like politics, religion, etc.
None of this is to say that we should pay attention to Dr. Immanuel. As far as I can tell, coronavirus treatments aren’t her area of expertise either.
JFA
Jul 31 2020 at 10:04am
“There are plenty of people who have done brilliant work in one domain, while having outlandish beliefs in others.”
Could you give a few examples? I have in mind Isaac Newton, who pursued research into alchemy. Alchemy may seem wacko to us, but it wasn’t necessarily wacko in his day (honestly, the idea of gravity was probably more wacko than alchemy in his day). Cultural context of beliefs matters quite a bit when imputing the wacko factor.
There might be several brilliant people who believed strange things (that were strange at the time)… but that’s a small (probably incredibly small) subset of people who believe wacko things. I’d say the vast majority of people who believe wacko things in one area probably believe in wacko things in another area… e.g., Immanuel’s belief in demon sperm *and* alien DNA used in medicine *and* lizard people. That doesn’t mean she’s wrong about hydroxychloroquine, but it probably means one should look elsewhere for opinions on that particular drug.
Salem
Jul 31 2020 at 1:15pm
A few examples at random – Ben Carson. Noam Chomsky. Frank Tipler. All brilliant – in their domains. All wacko outside of it.
I know smart people who believe the craziest stuff. Conspiracy theories. Pseudoscience. Religious gobbledegook. You are quite right that the cultural context matters. It’s not a coincidence, for example, that Ben Carson’s father was a minister. I think it’s a case of people taking a received position for pre-rational reasons, using their intellect to hone it to an extreme, and being too smart to be argued out of it.
Craig
Jul 31 2020 at 7:46pm
“too smart to be argued out of it.”
You sound like my wife. Great quote though, I am going to remember that and plagiarize it at some point.
Pierre Lemieux
Jul 31 2020 at 4:00pm
@JFA: You write that “the vast majority of people who believe wacko things in one area probably believe in wacko things in another area.” I think this is true and that it is rational, in order to economize on information, to give less credence to a person the larger the number of wacko things he believes (taking due account of his times and influences).
Jordan
Jul 31 2020 at 4:26pm
I believe that the naturalist Alfred Wallace—who independently conceived of the theory of evolution from natural selection—was also a spiritualist who believed in spirits and their meddling with mortals. Whatever your opinion on the compatibility of science and religion/spiritualism, the scientific community was uncomfortable with him and didn’t know what to do with someone who was an acclaimed scientist and simultaneously maintained non materialist beliefs. I think this is similar in nature to how we perceive political beliefs. Individual beliefs are very complicated, and heuristics about belief patterns can be misleading.
Kevin
Jul 31 2020 at 5:07pm
Bobby Fischer is the best example that I can think of.
Pierre Lemieux
Jul 31 2020 at 3:55pm
@Salem: I like your test but with three questions or caveats. How does one determine the limits of a field of expertise? What if two fields of expertise reach different conclusions (say, astrology and astronomy, or ecology and economics, or for that matter public health and economics)? And was Solzhenitsyn incentivized to hold true beliefs?
TMC
Jul 31 2020 at 8:39am
There are other studies as well:
Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows
https://www.henryford.com/news/2020/07/hydro-treatment-study
Lancet, New England Journal retract Covid-19 studies, including one that raised safety concerns about malaria drugs
https://www.statnews.com/2020/06/04/lancet-retracts-major-covid-19-paper-that-raised-safety-concerns-about-malaria-drugs/
American Journal of Epidemiology
Hydroxychloroquine+azithromycin has been used as standard-of-care in more than 300,000 older adults with multicomorbidities……These medications need to be widely available and promoted immediately for physicians to prescribe.
https://academic.oup.com/aje/article/doi/10.1093/aje/kwaa093/5847586
MB
Jul 31 2020 at 8:53am
You have straw manned the argument. There was not one doctor advocating using the drug, there were thousands that were willing to try it. I assume you are aware, as you seem so knowledgeable, the studies that you mention have been discredited/retracted because the data was crap (surgisphere). I am not advocate of hydroxychloroquine, I honestly don’t care – I hope the doctors and medical specialists figure it out. I will say it does not look like provides any benefit for most people – there could be a sub-population that benefits. I just want every other ignoramus to shut up, you can follow along but your opinions do not matter.
Thomas Hutcheson
Jul 31 2020 at 9:51am
Do these tools include understanding systems in which individuals pursuing their rational self interests with regard, say, to not wearing a mask, not getting vaccinated, or being in close proximity indoors to other people, or to operate an establishment in which these behaviors occur may cause unintended harm to other people? Do they give any guidance as to what if anything public officials should do or say in that situation?
Pierre Lemieux
Aug 2 2020 at 4:12pm
@Thomas Hutcheson: They might say or recommend what they want: it’s Mill’s argument. But, in my opinion, there is no good argument (or if there is one, it’s a very complicated argument that virtually nobody invokes) for allowing them to coercively favor one group in society and harm another group.
Alan Goldhammer
Jul 31 2020 at 10:01am
Free speech is something everyone should get behind. The same goes for calling out charlatans, snake oil salesmen and grifters who imperil public health by coming up with outrageous claims. I’ve been reading clinical studies on COVID-19 since mid-March when I started my daily Newsletter and it’s abundantly clear that HCQ does not work and falls into the category of a Zombie drug, refusing to go away. I group it right up there with amgygdalin (Laetrile) which continues to be touted as a cure for cancer.
Why various people persist in pushing unproven remedies is a job for behavioral psychologists. Editors of mainstream publications such as Newsweek need to do a better job of reviewing articles prior to publication.
Craig
Jul 31 2020 at 10:38am
“I’ve been reading clinical studies on COVID-19 since mid-March when I started my daily Newsletter and it’s abundantly clear that HCQ does not work and falls into the category of a Zombie drug”
And going to your website that you linked to, it seems that your statements actually have some value in the marketplace of ideas on this topic.
“Vice President for Scientific and Regulatory Affairs at the Pharmaceutical Research and Manufactures of America (PhRMA)”
That says to me that you have a good idea of what you’re discussing. So, for sure, as between you and Demon Doctor, nowithstanding the fact that you wear a funny looking bowtie, I would rightfully suggest, for sure, your evaluation carries more weight than Immanuel.
But I’m like the Professor on this topic, I am a layperson on the topic. I don’t know. I have read things about HCQ on this that are both positive and negative. Now there are things in the marketplace of ideas that you, given your expertise, may lead you, in particular, to give weight to.
I don’t have that expertise. So when I look at what you wrote here, from my point of view, when I view your website, you do seem reasonable, there seems to be some credentials that, while I am not personally familiar with, seem like they vest your ideas as having sufficient command over the subject material.
But then I see something like this: https://www.henryford.com/news/2020/07/hydro-treatment-study
“Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows”
They don’t seem to be discussing demon sperm. I see some guy in a white lab coat. When I google Henry Ford Health Systems, it seems to be a multi-billion dollar organization with tens of thousands of employees.
https://www.the-hospitalist.org/hospitalist/article/221227/arrhythmias-ep/hydroxychloroquine-ineffective-covid-19-va-study-suggests
“Hydroxychloroquine ineffective for COVID-19, VA study suggests”
This is an indirect link of course, but also, this seems like a reasonable source to me.
Now from your point of view, you may very well be able to assess the weight of the scientific evidence.
From my point of view, they both seem reasonable, I can’t give more weight to one or the other. Now with respect to demon doctor, the second she starts going off on demon sperm, I’m not going to give much weight to anything she has to say.
That being said the one thing that IS clear to me is that the efficacy of HCQ seems to be a POLITICAL issue, which is a shame actually.
Dylan
Aug 1 2020 at 7:35am
Craig,
I’m far from being an expert, but here are the things that stand out. This is an observational and retrospective study, where patients weren’t randomized into a treatment or non-treatment arms and there were criteria for who got the drug and who didn’t. They have tried to control for this in analysis, but the reason we do randomization beforehand is because it is impossible to control for every factor that might be relevant.
They’ve also excluded a bunch of patients from analysis (~14% of the intended to treat group) for reasons like they are still in the hospital or they were readmitted to the hospital during the study period. Those are fair reasons to exclude, because you don’t know the final outcome yet for those patients. but it can skew the results significantly.
Also, the group that was treated with HCQ or AZM or both, were twice as likely to also receive a corticosteroid or tocilizumab treatment compared to the non-treatment group, and those have been shown to have a benefit in randomized controlled trials.
This might all seem like a bunch of nitpicking to someone that isn’t very familiar with clinical trials, but those that are have become used to seeing what looked like big benefits in an observational setting disappear under proper trial conditions. So much so that back when I worked at a hedge fund that invested in biotech, the strategy was to short any stock that popped based on results from an observational trial.
The RCTs that we do have, including ones where patients are treated early and with AZM, continue to show no benefit. The link that William posted up top has a good review of the literature (if you can make it through the snark).
Pierre Lemieux
Jul 31 2020 at 4:11pm
@Alan Goldhammer: Thanks for the link to your newsletters archive. Is the daily newsletter accessible in real time?
FreeDrifter
Jul 31 2020 at 11:18pm
I don’t know whether HCQ is beneficial or not, but we will never really know, and falsehoods will only fail to be exposed, if we don’t allow ideas to clash like waves against each other, thus creating the foam of truth. Thus censoring those who support HCQ is just wrong, if not counter-productive (if you believe HCQ isn’t effective). Citing someone’s wacko ideas to undermine another idea they hold is, well, a logical fallacy: Pitagoras held a dogma that beans were somehow evil, and died for refusing to enter a bean field when chased by enemies. Does that mean that his famous theorem is wacko too? Let ideas clash and survive or not on their own merits, and the idea of dismissing ideas through ad Hominem attacks is, itself, a bad idea.
Dylan
Aug 3 2020 at 7:56am
For the most part, that’s what happened. When the hypothesis that HCQ might be beneficial first appeared, all the people i read who know this area were eager to do trials, while urging some caution borne from experience. Not everyone was that cautious though, I lost a lot of respect for one of the regular doctors on a morning news program, because he was recommending HCQ be given prophylacticlally, well before there was any kind of evidence supporting that.
Then the data started rolling in and, when it came to RCTs, it was almost uniformly no benefit to potentially negative benefit. Yes, there remain some observational studies that show benefit…but those are only good as a starting point for investigation. If, you’ve got a ton of well designed, randomly controlled trials across lots of patients at different stages of disease, with and without zinc and AZM…and they all converge around no-benefit, then you’re going to need extraordinary evidence if you want to suggest that it helps.
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