Hydroxychloroquine part two. Avoiding difficult dosing questions

A dance of regulation and research

A medical researcher dances with a drug regulator. AI artwork generated by stable diffusion.

This article follows on directly from my previous essay, “a toxic dose of hydroxychloroquine?”, and it won’t make sense unless you’ve read that first. The article was behind a wall, but it’s now available for all at the link below. If you like my work, subscriptions are what keep it going. Shares are the lifeblood of The Digger, so if you enjoyed my work please send it to others who may be interested.

Ok - if you’re all caught up, read on! It’s time for part two…

A toxic dose of hydroxychloroquine?

So why does all of this happen? Its a very difficult question to pin down, but by taking a look at the tension between public appearances and the RECOVERY trial’s paper trail, we can build a picture that can help us to understand.

Just four weeks after the RECOVERY trial’s hydroxychloroquine announcement, Professor Peter Horby was on UK television telling an educated audience of 1.8 million people there was “no reliable evidence” that the drug worked. By then, hydroxychloroquine had already become politicised, and add to that the polarising super-power of Donald Trump, and this concoction became an incredibly effective tool in muddying the water on HCQ. Trump had championed the drug, and just on that fact alone, it was almost natural that establishment opinion would turn against it. The culture war, it seems, can always be made use of by powerful interests.

Mixing up politics and science was an editorial line all too tempting for the UK’s top political journalist Andrew Marr. With Horby on his show, and the editorial line offered to him on a plate, Professor Peter Horby was all too happy to play ball. Below is the exact moment Horby discussed HCQ on the BBC, it’s taken from the Andrew Marr show which aired on May 10th 2020.

“It has well-known side effects, there are cases of people poisoning themselves with this drug” said Horby. It seems he was indeed aware that, used incorrectly, HCQ is dangerous. Why then, had Horby’s trial opted to give patients an initial dose of 620mg? A dose which UK toxicity database toxnet would consider toxic to anyone weighing 62kg or less?

What’s more, despite telling viewers there wasn’t any reliable evidence the drug worked, Horby forgot to mention that at that exact moment his own trial was investigating it. Patients were already being randomised to his trial in that exact moment, yet when he’s directly asked about hydroxychloroquine, he makes absolutely no mention of that fact. Isn’t that incredibly relevant to the question?

Otherwise confident, does Horby look a tad nervous as the conversation moves towards hydroxychloroquine? There are a few possibilities which might help us understand this.

Just three weeks after this interview, with 1542 patients enrolled on the apparently poisonous hydroxychloroquine study, the RECOVERY Trial announced they were stopping the hydroxychloroquine trial. The UK regulator and an independent committee had intervened, asking Peter Horby and Martin Landray to unblind the trial. Rather than let the data go to waste, they quickly concluded: “Hydroxychloroquine is not an effective treatment in patients hospitalised with COVID-19” in an update posted on The RECOVERY Trial’s website.

And that was that. Amidst a swirl of Trumpist confusion and controversy, the hydroxychloroquine trial was finished and the investigators publicised their conclusions. But why the sudden rush?

The was trial shut down in part as a response to a damning study published in The Lancet. This study not only suggested that was hydroxychloroquine ineffective against Covid-19 but that it was actually associated with an increased risk of death. The paper made a very strong claim that Hydroxychloroquine was contributing to the deaths of Covid-19 patients. It prompted the WHO to stop its trial investigating HCQ. It prompted warnings from EU regulators that hydroxychloroquine was associated with “cardiac arrhythmias and cardiac arrest.” In the space of a few short weeks, the literature and global attention on hydroxychloroquine were looking very worrisome and Horby and Landray’s study was caught in the headlights.

But here’s where things take a turn for the strange.