Al Brooks reacts to the recent study that put hydroxychloroquine (HCQ) back in the mix as a possible Covid-19 treatment and discusses the Munchausen syndrome.

Yesterday we discussed hopeful signs that the immunity from repeat cases of Covid-19 might be stronger than previously reported and a positive study on the use of hydroxychloroquine (HCQ) from a reputable source. Here we discuss what that does and doesn’t mean.

This is one credible study and the data are hopeful. But, it is retrospective, which weakens the conclusion. For example, the doctors were not following a protocol. Each could do what he wanted.

There were likely some doctors who chose to use HCQ on many patients with less severe disease. Other doctors might not have treated these patients with HCQ, believing they would do well without HCQ. This would result in the HCQ treated group including many patients who would appear to be responding to HCQ treatment, but in fact were going to do well regardless. HCQ would then appear more effective than it actually was.

But if the researchers can confirm their results with a prospective study where all the doctors make treatment decisions based on standards, that will renew interest among other researchers.

Hydroxychloroquine (HCQ) and Munchausen

Baron von Munchausen was an 18th century German soldier known for exaggerating his life’s experiences. Well, his name lives on in the medical world. There are patients who claim to have all kinds of medical problems when in fact they have none. For some, it is serious enough to be a mental disorder. The name is Munchausen syndrome.

Baron von Munchausen monument in Bender, Transnistria, Moldova
Baron von Munchausen monument in Bender, Transnistria, Moldova

He’s just a Turkey

When I was in medical school and a resident at the University of Chicago back in the 1970’s, we sometimes came across patients who kept returning with all kinds of symptoms. They were afraid that they had every latest disease that was reported on the news, and they insisted they had all the symptoms of each disease.

As doctors, we had to make sure that nothing was wrong. We do tests and our results are signs. What the patient tells us are the symptoms. You need both for a diagnosis.

Most of these patients were not mentally ill and did not have true Munchausen syndrome. However, many of the residents were annoyed by this kind of patient and applied a label to these patients that everyone immediately understood. Residents would call them “turkeys.” Because we had to evaluate the patient fully, it would add an hour to our day. We would get home at 11 pm that night instead of 9 or 10 pm. The doctors were resentful.

But there was another saying that motivated the doctors to do their job. They would always follow-up by saying that they had to investigate because “turkeys sometimes actually get sick.” The point is that sometimes something looks fraudulent but actually is real.

Experts can also be Turkeys

One of the problems HCQ faces is that its most vocal proponents are not mainstream medical experts. Instead, they are faux-scientific doctors (“Beverly Hills” types), conspiracy theorists, or people saying things based on politics and not science, like President Trump and Peter Navarro. Navarro is a PhD and he says that he can understand medical research as well as a medical scientist. He is a social scientist and a fool, not a medical scientist, and his claim is arrogant and nonsensical.

I am licensed to do brain and heart surgery, but I am not trained to do either. I would be a fool to contradict neurosurgeons or heart surgeons about what they are doing.

I was a medical scientist and I learned that medical data involves very complicated math. Only a fool would claim to be qualified to read it without a lot of experience in the field.

I have much more experience than Navarro in this area. I have written many peer reviewed medical papers and I was a peer reviewer for a premier ophthalmology journal. Also, I was a math major in college. Medical research math is not easy. Even the researchers do not do it themselves. They have statisticians who specialize in medical research do the analysis because there are always subtle points that must be considered.

For example, the half-life of HCQ is long and it can sometimes still be in your body two to three months later. A person who took it a month before joining a study could be in the placebo group. That could make the results of the placebo group similar to those in the HCQ treatment group. Someone might conclude that HCQ was no better the placebo when in fact many placebo patients had HCQ in their systems.

A good statistician must account for that, but someone reading the study might not realize it. So, in fact, properly prepared data might actually correctly show that HCQ was not helpful.

Remember, there are proven Covid-19 treatments with clearly positive results.

Tomorrow, I will delve into the problem of pseudoscience and the Importance of relying on real scientific validation in treating illness.

Al Brooks’ earlier special reports on the Covid-19 pandemic:

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