Does the 'Hydroxy' Really Work? Let's ask an 18th Century Presbyterian Minister

A video of what appears to be a very passionate, articulate and esteemed physician has been making the rounds recently.


Surrounded by about 10 other medical professionals in white coats, she made an impassioned plea that Hydroxycholoroquine (HCQ), a malaria drug, really does cure severely ill Covid-19 patients.

She made a very convincing case for the drug:
  • 350 patients under her care in a major hospital in Houston.  All cured.  
  • Why is the 'establishment' trying to slow things down with double blind studies, which take forever, when people are dying???  We can save lives by using it now.
  • HCQ + a Z-pack.  It works.  She knows.  She is on the front line every day, curing people of Covid.
However, I have recently heard that HCQ is unsafe, and not really effective.  And it seems really politicized too.  

How is a thinking, caring person supposed to reconcile this video with conflicting news from other sources?

The Bayesian Approach

Well, let's ask a 18th century presbyterian minister:

Thomas Bayes (/beɪz/; c. 1701 – 7 April 1761) was an English statistician, philosopher and Presbyterian minister who is known for formulating a specific case of the theorem that bears his name: Bayes' theorem (source: Wikipedia).

 
The basic idea behind Reverend Bayes' thinking is called Bayesian reasoning.  It is very powerful, simple to understand and can be summarized in a three-step process:

The first step is to carefully define what is called the prior before considering any new evidence:
  • The prior:  What kind of evidence do we currently have about HCQ and how confident are we in that information?
The second thing is to consider the new evidence, once we have the prior firmly in mind:
  • What new evidence is the doctor presenting on HCQ and how strong is that evidence?
The third and final step is to add the new evidence to our thinking and use it to determine what is called the posterior probability:
  • Posterior probability:  After factoring in both the strength of the prior and the confidence we have in the new evidence, how much did the prior change? 
Let's put this three step process into action.

Defining the prior

A quick internet search can pull up lots of information on the application of HCQ to the Covid-19 disease:
  • In March, a French physician, Didier Raoult announced the result of a study of 24 people that showed the effectiveness of HCQ in treating Covid-19
    • The study was not randomized nor was it controlled
    • The study was later peer-reviewed as irresponsible by a distinguished Dutch researcher (reference here, use Google translate if you don't read French)
    • A statistical review later in March cast doubt on the conclusions of this trial.
    • In April, the journal that published the study announced that it did not meet the expected standard of the publication
    • Independent research groups throughout the world could not replicate the results (Examples here and here)
  • On March 19th, president Donald Trump promoted the drug in a press conference as being effective for Covid-19
  • In March and April, many scripts were written for off-label use for HCQ, causing a severe shortage for patients with lupus and other auto immune diseases
  • The FDA issued an emergency use authorization (EUA) for HCQ use in treating Covid-19 on March 28
  • Many more recent well-controlled studies, documented in prestigious journals and peer-reviewed have shown no benefit for HCQ in treating Covid-19 (for example here and here)
  • On June 15, the FDA retracted its EUA for HCQ
  • An observational study published on July 1 from the Henry Ford Hospital System found that deaths were 50% lower for Covid-19 patients treated with HCQ
The evidence looks very strong for the absence of effectiveness for HCQ when used to treat Covid-19. The original study in France has been thoroughly discredited.  However there is that one study (Henry Ford Hospital) that does give a glimmer of hope, but since it is observational only, it does not carry nearly the weight of the other evidence.

Looking at the New Evidence

Let's look the facts surrounding this new evidence:
  • The physician's case is pretty straightforward: Her experience is that she has seen 350 people recover from severe Covid-19 disease under her supervision.  She has concluded that, based on her observation and experience, that the recovery is due to treatment by HCQ and Z-packs. 
  • The physician's name is Stella Immanuel.  Dr Immanuel graduated with a medical degree from the University of Calabar in Nigeria - and has a valid doctor's license, according to the website of the Texas Medical Board.
  • Dr. Immanuel is also a pastor at the Fire Powers Ministry and has used that position to advocate the following theories (reference BBC):
    • Alien DNA is being used in medical treatments
    • Scientists are creating a vaccine to prevent people from being religious
    • Blames medical conditions on witches and demons, which have sex with people in a dream world
    • Stated that gay marriage can result in adults marrying children
    • Offers a prayer to remove a generational curse, received from an ancestor but transmitted through the placenta
  • Dr. Immanuel made the assertion in the video that double blind studies are not necessary to evaluate the effectiveness of a drug or treatment.
  • The event was sponsored by the Tea Party Patriots, an organization seeking to re-elect president Trump and the video was live-streamed by Breitbart News, a conservative media outfit.
  • The other people in white coats in the video are "America's Frontline Doctors" - a newly formed group of about 10 physicians who believe that neither masks or shutdowns are necessary to control Covid-19
  • The event takes place on the steps of the Supreme Court in Washington, DC
Before we admit this as evidence, we need to evaluate the strength of it.  To do this, we will investigate the credibility of the source, examine the circumstances and scrutinize any potential motivations that may be taking place.
  • Although Dr. Immanuel is a licensed physician, she has some highly unusual theories and views which significantly weaken her credibility in making scientific observations and drawing unbiased conclusions.  
  • In addition, Dr. Immanuel's lack of confidence in double blind, randomized, controlled studies sets her against the vast majority of scientists, doctors and researchers throughout the world who use this process exclusively to qualify and certify medical treatments.
  • The organizations that are sponsoring and live-streaming this event have a big motive to promote HCQ as a cure for Covid and are not unbiased.  
    • Donald Trump has made HCQ into a highly charged political issue: He went out on a limb and publicly promoted a very doubtful treatment in the middle of a national tragedy. 
    • The president continues to advocate this treatment (despite recent evidence that it is ineffective), in effect making it part of the case for his re-election.
    • If the public can be convinced that Mr. Trump was correct in promoting HCQ with little evidence, his image is strengthened significantly.
It appears that the evidence presented in the video is considerably weakened by both the credibility of the presenter and the motives of the sponsoring organizations.

Posterior Probability

Given the strength of the prior, and the weakness of the new evidence, it is highly unlikely that the prior has changed in light of the new evidence.  I would argue that the prior probabilities are unchanged by this video.





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