In the first six months of the pandemic, research from China (among other labs) indicated with in vitro studies that hydroxychloroquine (HCQ) had potential as a treatment for COVID-19. These revelations created a mini-firestorm in the media rather quickly, and then seemed to fizzle out after a few weeks. Subsequently, people began to wonder if information about the drug was being suppressed. On one side, people took off-label versions of HCQ, resulting in a few deaths. On the other side, some doctors were prescribing it and claiming it to be a miracle cure.
This all stems from a misunderstanding of the scientific research itself. For starters, the Chinese research was far more limited than people initially realized. In vitro means “in glass”, that is, it’s an experiment where cultured virus is directly exposed to a stimulus and the response is measured. While often this is a useful starting indicator for whether or not a drug or chemical has efficacy potential, it is just that: a starting point. To wit, the early research set off a number of clinical trials looking at the efficacy of HCQ in multiple settings. But clinical trials take time, and that’s why fervor around HCQ seemed to die down shortly. It wasn’t that things were being suppressed, it’s that doing additional research in human bodies (in vivo) is not a trivial thing to execute.
The clinical results, unfortunately, weren’t great. Across the board, HCQ didn’t turn out to be a favorable treatment compared to alternatives. (For a few examples, see NEJM here and here, and Clin. Inf. Dis. 2020.) A miracle cure it certainly was not. What of the above-linked doctor from Houston and her patients who supposedly saw results with HCQ? While we can’t fully rule out that it was effective in their case, we have to note that these patients were often preemptively prescribed HCQ or they were suffering only very mild symptoms. In other words, not only were the data extremely limited, lacking controls, and not sufficient to be considered a clinical trial in the least, but the patients were not in a disease grouping that realistically warranted any treatment at all and were extremely probable to get well on their own without any kind of pharmaceutical intervention. (A rather acerbic but useful critique of HCQ usage can be found here.)
Of course, over time we saw less and less discussion of HCQ as the evidence overwhelmingly was against it as an efficacious treatment for COVID-19. But, now we continue to see similar sorts of stories driven around Ivermectin. It’s ridiculous that on one side, we see unreasonable ferver popping up again for its use, while simultaneously on the other side it’s mocked as being “horse de-wormer”. The fact is, both sides are reactionary. The evidence that it could work is still under investigation, and while that is the case it is, thus, premature to make strong pronouncements or denunciations. The trial results for Ivermectin are a bit mixed so far. Some early data suggested good efficacy, but the methods were somewhat questionable. The I-Tech trial released in February 2022 indicated that Ivermectin wasn’t as good as alternatives. But then again, the intervention is cheap and the side-effects were not awful, so we may still see further research to drill down specific cases where it may be better than others. Time will tell, there’s still work to do.
You should be free to seek treatments that are in line with your personal views, for sure. But, it’s generally not a great idea to take completely off-label, unprescribed drug products. At best, you’re doing something that is not ultra-risky but won’t really do anything either. At worst, you mistakenly dose yourself and the results, in that case, can be quite bad. To me, that’s not really worth it.
In the end, the point of all this is to help us realize that reactionary narrative-building around science is often unwarranted. We see this with pharmaceutical development, yes, but this is also applicable to government measures to combat disease as well. We’ve definitely seen this with government pronouncements about lockdowns and masks, as explained in previous Pandemic Bites emails. Keeping a sober mind through it all is what we need to seek after, and we should resist when governments, in particular, operate under the pretense of knowledge that they certainly do not have. We’ll all be better for it.