LAST Thursday the medical journal The Lancet formally retracted a now-notorious paper ‘Hydroxychloroquine or chloroquine with or without a macrolide for treatment of Covid-19’. Claiming to analyse around 96,000 cases worldwide, it concluded that neither hydroxychloroquine nor its combination with azithromycin (a ‘macrolide’) worked as a cure for Covid-19. Indeed it increased the death rate.
This was not any old science paper. It analysed (or said it did) the largest ever cohort of Covid-19 patients, was accompanied by an editorial ‘Commentary’ and BBC Radio 4 was briefed to cover it the same morning, Friday May 22. Today was on top form, clearly announcing as baseless the hope that these anti-malaria drugs, touted by Trump, might be a cure for Covid-19. By the following Monday the World Health Organisation had suspended its clinical trials of hydroxychloroquine and asked other countries to do likewise, and moreover to please stop using the drug at all. (It was largely ignored.)
Though irrelevant to the use of hydroxychloroquine in early infections (patients were all hospitalised) the title was carefully crafted to blow a hole in the idea that hydroxychloroquine combination therapies would work against Covid-19. It covered both the older chloroquine and the newer hydroxychloroquine to be sure. Possible adjunct antibiotics were expanded from the widely-used azithromycin to ‘a macrolide’ to cover a few more bases. But internet sleuths worked on the company providing the alleged registry of patient data, finding impossible correlations, more patients than existed at key dates, lack of ethical or data protection clearance, and so on.
The authors and The Lancet doubled down, publishing a petty correction about hospitals in Asia and Australia being wrongly assigned, but insisted that it did not change the conclusions. An open letter from 200 medical luminaries demanded an independent investigation. By the time Twitterati found suspicions that the CEO of the database company moonlighted as a male model and a marketing executive as an ‘adult’ actress, the house of cards was collapsing. The retraction had face-saving words, but the paper was exposed as based on data unverifiable at best, or outright fabricated: classic fake news. Yet it came from a medical journal proud of its heritage and prestige, had sailed through the peer review process and The Lancet stood solidly on its dignity for a whole fortnight.
On cue the next day, Friday, conveniently distracting from the embarrassment, the Oxford RECOVERY clinical trials (with no full paper) announced that there was no improvement in mortality with hydroxychloroquine: a shocking quarter of patients died whether or not they were given the drug. One major problem with the RECOVERY trial of hydroxychloroquine is that patients were already in the ‘inflammatory’ stage of the illness, when hydroxychloroquine is not expected to help. Findings merely confirmed what successful clinicians have insisted on for months: you must treat early. At the Marseille University Hospital, the fatalities are 0.9 per cent, something very different. Another problem, as Joseph Berry has pointed out on TCW, is that the study published in The Lancet did not cover the use of hydroxychloroquine with zinc. The media message however was simple: hydroxychloroquine doesn’t work.
So what on earth is going on? The problem is that a cure for Covid-19 exists: simple, safe, dirt cheap and ready for instant use by GPs or equivalent primary care doctors around the world. Few of us need to be frightened of Covid-19 so long as we have some cheap medicines in the bathroom cabinet, or at least access to prescriptions from GPs. This is a huge problem for a major industry; not that a cure has been found, but that it costs next to nothing, and therefore has zero profit potential. There is no fortune to be made from expensive designer drugs if the disease can be cured in its early stages with cheap ones. The pharma industry can spot this a mile off. Worse, it threatens the well-nigh universal idea that only a vaccine will fix it, that the world will never be the same again until a vaccine is dispensed worldwide, possibly whether you like it or not. These threats extend to the substantial number of research institutes and university departments funded to develop designer drugs and vaccines. The required messaging is therefore that re-purposed generic drugs do not work, or are dangerous, or both. Those who can be persuaded to supply such messaging are rewarded. This does not have to mean anything as crude as bribes for fraud; encouragement by funding work on a legitimate caution can be enough, if spread widely.
In the USA there is the added dimension of a Presidential election, and the overpowering need by Trump’s opponents neither to admit that he might actually have got something right, nor to end lockdown policies whose ruinous effect they hope to blame on the President. Trump opponents heavily vested in the pharmaceutical industry have dual incentives. In the UK, industry lobbying is just as real, if much better concealed. Add a political class continually claiming to ‘follow the science’ whilst unqualified to do anything of the kind, the result is a perfect storm of political, commercial and ideological interests that have captured the apparatus of government.
How directly such influences worked on the now-retracted Lancet article, and the powerful publicity given to it, is impossible to say. It looks as if the authors were ‘believers’ who thought they were doing something clever with a large database. ‘Big Data’ methods are fashionable, and cardiologists have a legitimate concern with dual use of two drugs both known to lengthen heartbeats. But the potential value chain threatened by a cheap and simple cure is enough to condition the behaviour of many.
The innocent may sense a moral difficulty. Haven’t lots of people died of Covid-19? Aren’t some still dying? Shouldn’t we be pursuing treatments that work, and using them as soon as possible, especially if drug tolerance is already well known? Shouldn’t we put the NHS back to work on all the other illnesses, and the rest of us to our own lives? In the grip of such naïvety, I wrote to my MP on April 3, alerting her to the hydroxychloroquine-based treatments developed by Didier Raoult, the Professor Dumbledore lookalike in Marseille, and variants elsewhere. My MP has still failed to extract any response from the Department of Health and Social Care.
For avoidance of doubt, the emerging empirical proposition for an early cure is (i) hydroxychloroquine (ii) in combination with azithromycin and/or zinc (iii) within the first few days of symptoms. Papers and public domain reports from active clinicians in several places show that this cures the majority of Covid-19 cases without hospitalisation. I know of no reports anywhere that contradict. Equivocal or negative reports turn out on close reading not to deal with combination therapies, or not to control for zinc, and the majority (including the latest clinical trials from Oxford) concern severely ill hospitalised patients well into the ‘inflammatory’ phase of the illness, when anti-viral treatments are not expected to work.
Snake oil? By all means do your clinical trial; let’s nail it. Yet there remains no UK clinical trial of the empirical proposition as stated. The PRINCIPLE trials, based in GP practices, are the closest, but currently address only hydroxychloroquine alone or azithromycin alone. Though hydroxychloroquine is a known ‘zinc ionophore’ (a chemical which allows zinc to get inside living cells) the protocol does not control for zinc. Refusing to test therapies empirically reported as successful puts such trials in the same league as the philosopher-theologians who refused to look through Galileo’s telescope.
By April 3 there were 4,461 Covid-related deaths in the UK. Two months later there have been 40,465. Tens of thousands may have been preventable, at least from Covid-19. Our deaths per million are now the second worst in the world. The UK is beginning to look very stupid indeed, with a ruined economy, our ancient liberties massacred, major illnesses such as cancer neglected, and comprehensive failure even in the claimed mission of ‘saving lives’.
‘There is no treatment’ is unsustainable when pro-active early treatment is being pursued successfully elsewhere. With the Lancet affair, inevitably tagged #LancetGate, it is high time for the Government to abandon the unsustainable, and face down the vested interests still trashing a simple cure, available months ago.