Re: Questioning Conventional Wisdom - The virus
My impression was that experience with chloroquine has been negative for COVID-19. I did not mention this drug.Originally Posted by ilikenails
I think you have misapprehended my intention of saying "as a scientist". It was not intended as an appeal to authority. My intention was to indicate that the opinion to follow was, in some sense, against my nature. I also felt that, as a member of the club, I was entitled to my opinion. But it was stated only as an opinion, and if you disagree, you are entitled to say so. I have no objection whatsoever, though I would be happier to receive it if it were offered in a less caustic manner. I have been known to change my opinions when presented with sound arguments.
The premise I articulated was that the clinician determines that the proposed treatment will likely do no harm. I certainly never suggested that such medications be made available without a prescription. At the time I made that remark, Fauci had been advocating for a normal scientific approach of proving that the drug was effective in randomized double-blinded trials before utilizing hydroxychloroquine for COVID-19 treatment except for "compassionate use" circumstances. A little back-of-the-envelope math suggested that if hydroxychloroquine actually does help, it would be weeks at a minimum before any preliminary data was available, and even that would require a bit of magic in order to conjure up the administrative details to put a study in motion. I do not know whether he changed his mind or his preferences became irrelevant, because my understanding is that it is now being used more generally. Whether it is effective remains an open question, I suppose.
Generally, for a prescription medicine to be approved for something, it should be proven both safe and effective (relatively). We cannot rush the deployment of a vaccine, for example, because it would be a completely new vaccine, and we would have no way to know it was safe. It might or might not even be effective, but having no safety data makes the risk of doing harm very high. In the case of hydroxychloroquine, we do know the drug's side effects, so a clinician prescribing it for COVID-19 knows what to watch out for. While we don't know what dosage would be effective for COVID-19, if any, we do at least know some dosage information for on-label uses. Naturally in a given case it could be contraindicated. I'm not saying it should be used. Rather, that it should be up to the clinician, not the scientist, to determine whether to give it a try.
The word "parochial" is a segue into another way of looking at it. I used the word "parochial" to mean "having a limited or narrow outlook or scope." The "parish" I had in mind was that of the medical researcher operating in normal circumstances, the concept of the church and its dogma being replaced with the unbending requirements of the scientific method, which in this case mandates the use of double-blinded randomized controlled studies to determine safety and efficacy before approving of the use of a drug. Within this "parish", the scientist is concerned with proof, and he isn't wrong about what is required to establish that proof. While he may feel pressure to proceed as quickly as possible, he does not question his core assumption that proving efficacy is a prerequisite to using the drug. We do have the aforementioned "compassionate use" exception for exigent circumstances, but how can we apply that here, given the way COVID-19 kills when it kills? We don't know who will develop ARDS and who will not, and compassionate use only applies once a great deal of lung damage is done. We're not talking about a cure, rather a substance that is believed to reduce the viral load. You could restate my opinion as asserting that, for this drug, clinicians needed a broader exception than "compassionate use".
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