The nature of our national conversation — how we think, and how we talk about things that matter — is supremely frustrating, and the debate about chloroquine and hydroxychloroquine as potential treatment for COVID-19 is a prime example.
We now have motivated reasoning at work in the discussion of choroquine and hydroxychloroquine, in large part because President Trump keeps mentioning it in his briefings. Yesterday, the president said, “What do you have to lose? Take it. I really think they should take it. But it’s their choice and it’s their doctor’s choice, or the doctors in the hospital. But hydroxychloroquine — try it, if you’d like.”
Because every issue in public life seems to come back to Trump and what people feel about him, many anti-Trump voices want to focus on the evidence that it doesn’t work and could be potentially dangerous if misused, and many pro-Trump voices want to focus on the evidence that it does work.
Yesterday, in an interview on CBS, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases at NIH, tried to summarize the most accurate answer on hydroxychloroquine: It depends upon the patient.
MARGARET BRENNAN: Very quickly, is hydroxychloroquine preventative against this virus? Yes or no?
FAUCI: You know, as I’ve said many times, Margaret, the data are really just at best suggestive. There have been cases that show there may be an effect–
MARGARET BRENNAN: Yeah.
FAUCI: –and there are others to show there’s no effect.
MARGARET BRENNAN: OK.
FAUCI: So I think in terms of science, I don’t think we could definitively–
MARGARET BRENNAN: All right.
FAUCI: –say it works.
We’ve all seen commercials for prescription drugs, where after showing happy people dancing in a field of flowers, the announcer warns: “Use of mélange may include side effects such as nausea, dizziness, drymouth, loss of bladder control, hallucinations or expanded sensory perceptions, eye discoloration, precognition, acute to severe megalomania, and the ability to navigate interstellar distances from the planet Arrakis. Do not taunt Happy Fun Ball,” and so on.
Those warnings are in there because a medication can have wonderful effects in one person, with few or no side effects, and then can have terrible side effects in another person. Human beings have different physiology and different metabolisms, and this means that the same substance can effect different people in different ways. What’s more, your metabolism and organ function change as you age, so a medicine’s effect on a person at one time in their life may be different from the effect at another time in their life.
In addition to a patient’s age, the effectiveness of a drug can be altered by any one of many factors — the patient’s genes, the presence of other medication, time of day, the presence of food in the digestive system (this is why some medicine is taken with, before, after, or some time apart from meals), gut microbes, whether you smoke, pre-existing medical conditions, and so on. If this stuff were simple, a form of cancer treatment that works on one person would always work on everyone else.
There are enough examples to conclude that chloroquine can be effective in some coronavirus patients. But if chloroquine worked all the time, we would have this virus beaten already.
Apparently we as a society cannot handle nuance, and we cannot comprehend the concept of “sometimes, but not always.”