Last updated by The POOG on August 01, 2020.

Background to the Debate

The safety and efficacy of hydroxychloroquin (HCQ) has been under vitriolic attack for purely political and economic reasons.

The first reason is that President Trump came out in support of it. This meant that the Democrats and all interests that want to see Trump defeated this fall have to oppose it immediately and create the impression that it was dangerous and ineffective.

The second is that Big Pharma that pays the representatives to do their bidding, must oppose it because they can’t make any money off of it. HCQ is a generic drug that sells for pennies a dose. Big Pharma wants to peddle a vaccine of questionable efficacy and safety that can potentially be sold for $100 a dose or more to a global population. That amounts to trillions in revenues.

It is important to frame the argument correctly. The claim is that clinical use of HCQ has a high efficacy if:

  1. it is used in combination with azithromycin (brand name Z-Pak) and/or zinc;
  2. it is administered early, either as a prophylaxis before the onset of symptoms, or within the first couple of days after symptoms emerge; and
  3. it is administered in dosage levels commonly used in those clinical applications reporting high efficacy.

No claim of efficacy is made for treatment begun late in the infection for patients who are critically ill.

For a study to invalidate this claim, the study must meet both conditions. Otherwise such a study is inapplicable to the debate.

In this paper, references used will be identified by a number in square brackets, e.g. [1]. Papers cited will be referenced by lead author as in Arshad (2020). Emphasis may be added in quotes to highlight key points.

References [1],[3], and [5] collect many of the reported results and we will not try and reproduce their work here.

The History of HCQ

HCQ and its progenitors have been in use for more than four centuries[4]. Early modern use has been as an antimalarial drug[2]. In recent years it has found

routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as those with a low-level inflammatory arthropathy.

Gold, reference [3]. Also, [2].

It enjoys the endorsement of the ACR and EULAR.

Most recently, it has been used in clinical settings by numerous doctors who can attest to its efficacy. This paper identifies many of the studies and reported results to date.

Side Effects

under construction

Conclusion

The clinical evidence is that, used as in the claim for the drug in this paper, it is highly effective as a treatment for the disease. Anyone who states otherwise should be challenged to produce the relevant studies or data. Repeating something attributed to “authorities”, “experts”, or “science” carries no weight without the primary verifiable studies underlying the claim. Unfortunately, this is exactly the approach used by those suffering from ignorance and a lack of critical thinking.

References

  1. Global HCQ studies.
  2. Hydroxychloroquine. Drugs.cm.
  3. Medical Studies Support MDs Prescribing Hydroxychloroquine for Early Stage COVID-19 and for Prophylaxis. Vladimir Zelenko, M.D., Harvey A., Risch, M.D., PH.D. and George C. Fareed, M.D.
  4. The Nine Lives of Hydroxychloroquine. Martin J. Bergman, MD, May 11, 2015.
  5. White Paper on Hydroxychloroquine. Dr. Simone Gold, MD, JD.
  6. An Effective COVID Treatment the Media Continues to Besmirch. Steven Hatfill, Real Clear Politics.

Citations

  1. Arshad, S., Kilgore, P., Chaudhry, Z.S. et al. Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19. Int. J. Inf. Dis., Volume 97, P396-403, August 01, 2020, DOI:https://doi.org/10.1016/j.ijid.2020.06.099
  2. Boulware, D.R., Pullen, M.F., Bangdiwala, A.S., et al. Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med June 3, 2020; DOI: 10.1056/NEJMoa2016638.
  3. Carlucci, P., Ahuja, T., Petrilli, C.M., et al. Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients. doi: https://doi.org/10.1101/2020.05.02.20080036.
  4. Mikami, T., Miyashita, H., Yamada, T. et al. Risk Factors for Mortality in Patients with COVID-19 in New York City. J GEN INTERN MED (2020). https://doi.org/10.1007/s11606-020-05983-z.
  5. Modjarrad, K., Roberts, C.C., Mills, K.T., et al. Safety and immunogenicity of an anti-Middle East respiratory syndrome coronavirus DNA vaccine: a phase 1, open-label, single-arm, dose-escalation trial. Lancet Inf Dis Volume 19, ISSUE 9, P1013-1022, September 01, 2019; DOI:https://doi.org/10.1016/S1473-3099(19)30266-X
  6. Scholz, M.; Derwand, R.; Zelenko, V. COVID-19 Outpatients – Early Risk-Stratified Treatment with Zinc Plus Low Dose Hydroxychloroquine and Azithromycin: A Retrospective Case Series Study. Preprints 2020, 2020070025 (doi: 10.20944/preprints202007.0025.v1).
  7. te Velthuis, A.J.W., van den Worm, S.H.E., Sims, A.C., et al. Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture. Plos Path. November 4, 2010; https://doi.org/10.1016/S1473-3099(19)30266-X