Hydroxychloroquine is the cure (that doesn’t always cure)

Recent news made me look up the definition for the word “cure”.  Merriam-Webster offered me four definitions.  I decided to use definitions 2c (a course or period of treatment) and 2a (recovery or relief from a disease) in the composition of this blog title, Hydroxychloroquine is the cure (2c) that doesn’t always cure (2a).

However, it looks like a lot of hopeful people took the bait of a recent press event by a group of careless doctors who used the word “cure” in asserting there is a cure for COVID-19.  Why do I assert they are careless?  Doctors are educated in a certain way, and should know not to use the word “cure” when it is not warranted, given its popular and common meaning.

How do I know it is not a cure (2a definition)?  Peer reviewed articles like this one, published on July 1, 2020.  If one takes the time to read and understand the results, it is clear that mortality still occurs with hydroxychloroquine treatment (range of 13.5-20.1% mortality rate).  When somewhere between 1 in 5 and 1 in 7 COVID-19 patients are dying, despite being administered hydroxychloroquine as the cure (definition 2c), I think it’s fairly easy to say that hydroxychloroquine does not cure (definition 2a) COVID-19.

Still, the results of this observational study certainly indicate that controlled studies of hydroxychloroquine as a treatment for COVID-19 are needed.  The scientifically literate reader will note that there is a big difference between an observational study of this sort, and a well designed and controlled study of the type where strong conclusions can be reached.  The limitations of this observational study were noted in an editorial in the very same journal, the day after this article was published.  Note that the editorialists are polite, commending the authors of the article, but also expressing skepticism, indicating the observed results do not constitute high quality evidence to support hydroxychloroquine as an effective treatment for COVID-19.

I do wonder how well those with limited science and research backgrounds do with reading and understanding content in a peer-reviewed science journal.  We also know that mathematics competency in the U.S. adult population isn’t very good.  I know it is tempting to latch onto any claim that there is a cure or effective treatment for COVID-19.  Even doctors can be fooled by their experiences with patients.  For example, using the results from the published article we know that a doctor would see somewhere between 4 of 5 and 6 of 7 patients who were given hydroxychloroquine recover from COVID-19.  That’s a lot of recoveries.  So are the 3 of 4 recoveries that occurred without any hydroxychloroquine treatment.  Without a controlled study, and good statistical analysis, one can easily be fooled into making a premature incorrect conclusion.

It's also important to pay attention to the type of patients subjected to a study. In this most recent case, these were hospitalized patients. In this accepted manuscript, published in May 2020, note that the patients were outpatients, rather than hospitalized. Efficacy of a treatment with one type of patient does not necessarily confer benefit to the other. Yet, it certainly seems that there is sufficient reason to continue research on hydroxychloroquine as a treatment for COVID-19, as it may very well have some benefit for some types of patients, under certain conditions. There are other studies underway, and it will be interesting to learn their results.

Unfortunately, the cat is out of the bag, so to speak, in part due to these careless doctors, and in part due to our careless president, so I fear that if additional controlled studies indicate hydroxychloroquine is ineffective, a whole lot of people will continue to believe it is, and the facts simply won’t matter. Let's hope for the ongoing studies to show clear and conclusive benefit.