Hydroxychloroquine and the Problem of Western Medical Exceptionalism

Is cultural hubris stopping us from saving Covid-19 lives?

Photo by Austin Distel on Unsplash

August 3 2020

Such is the intense nature of reality at the moment — pandemics, racial reckonings, mask wars, and the looming celebrity-killing spectre of Ghislaine Maxwell’s testimony — it is easy to forget that the reality we see playing out in front of us might be far removed from the reality in other parts of the world.

Take, for example, the current kerfuffle about Hydroxychloroquine (HCQ), a previously uncontroversial anti-Malaria drug that has now transformed into everything from a miracle ‘Rona cure to a cardiac arrest in tablet form.

Things got real in America when a group of outspoken Doctors held a press conference spruiking its benefits, leading to swift, coordinated and almost indefensible social media censorship of the viral video clips that followed.

As I wrote about previously, we needn’t limit the debate about the merits of HCQ to this divisive event, including one particularly divisive Doctor. There is now a fair body of scientific literature to work with that provides genuinely good news for the drug’s effectiveness: as best summarised in this highly convincing Newsweek piece by respected Professor of Epidemiology Dr. Harvey A. Risch. This piece also summarises the flaws in the major studies that have found no benefit in COVID-19 patients, the same studies that are almost gleefully trumpeted in the mainstream news articles that you see first in any internet search on HCQ.

However, one fact that hasn’t gained as much attention in this debate as it should have, including in my own piece, was the apparent success of HCQ in treating COVID-19 patients in other, notably non-Western countries. It will probably surprise many people that almost a dozen countries have, routinely and uncontroversial, included the drug in their treatment regimes.

This began early in the pandemic, when in February Chinese authorities unanimously declared chloroquine (to which HCQ is functionally equivalent) to be the most promising treatment for COVID-19 out of tens of thousands of available drugs. At approximately the same time, South Korean disease experts began recommending HCQ along with another HIV drug Kaletra.

In India, HCQ has been prescribed both for early-stage treatment and for prevention, with its use in densely populated slum areas suggested to have helped in avoiding a potential public health disaster. Malaysia have also used the drug, with its Health Director General going as far as crediting it with having slowed the rate of COVID-19 progression in its population.

The list goes on. Bahrain, Turkey, Jordan, the United Arab Emirates, Morocco, Algeria, Nigeria, Senegal, Cuba, and Costa Rica have all used the drug and claimed some degree of success.

One graph floating around social media attempts to compare the performance of the pandemic across nations with no, mixed and widespread use of HCQ. While its creator openly admits the graph is not perfect, and is intended only to provoke thought and discussion, it does show one stark fact: those countries who have not used HCQ are almost exclusively from the West. In fact, there is not one country that we might associate as being part of the Western power bloc that falls under the ‘HCQ Use’ category.

Graph of case fatality rates for countries based on HCQ use (Source)

It is beyond my expertise to even begin to assess the extent to which the use of HCQ has contributed to the consistently better pandemic performances of these countries. But that is largely besides the point for these purposes: the point is that they did use them, without fanfare, politicisation and despite pressure from governing bodies like the World Health Organisation.

So what makes us in the West special?

I proposed several potential reasons for why, against so much available evidence, HCQ continues to be demonised and shunned as a treatment for COVID-19 in major Western nations. We have the obvious politicisation that occurred when Donald Trump decided to make himself a guinea pig; we have the undeniable influence of Big Pharma and the threat that the cheap and un-patented HCQ poses to lucrative money making ventures within the health system; and we have what seems to be a pervasive social conditioning to reject any evidence that this pandemic might not actually have to be as bad as we have been lead to believe.

But what if it is something else, something a little deeper and arguably more insidious than that. What if we actually just think that we are smarter?

That these other nations that have yet to be blessed with the full extent of Western medical exceptionalism couldn’t possibly have found an effective treatment before we have. That it is ok for these backwater countries to be the testing grounds for new experimental medicines, just like they have been for many of our vaccines — but in the West, we couldn’t possible roll this drug out until that fabled gold standard that is the Randomized Controlled Trial has been satisfactorily obtained. Except, it appears that one such RCT was just shut down by the Anthony Fauci-lead National Institute of Allergy and Infectious Diseases.

In an ideal world, we would wait for further, absolutely conclusive evidence. But these are far from ideal times. And this is not an unknown compound that we are talking about: to reiterate probably the most important fact in this whole debate, its safety as a treatment for malaria — as well as other chronic diseases such as lupus and arthritis — is well established, including for all age groups as well as pregnant and nursing mothers. Perhaps the only real concern we should have for providing this drug for COVID-19 patients is that it does not inhibit supply for its existing users.

If these countries saw fit to accept any risk that the widespread use of HCQ brings, why haven’t we?

I have no idea what role our smugness in our own medical advances is playing in this stubbornness, even if I have my suspicions. What I would suggest is that it should be front of mind of every individual who has criticised the West for patronising the rest of the world in other domains of international relations. Was it just a coincidence that the Doctor who so triggered the Western medical establishment with her bold, IDGAF speech in support of HCQ got her degree from one of the nations — Nigeria — that has used the drug effectively?

It should also be front of mind for every person who has criticised the apparent ignorance of other individuals — whether they be mask deniers, quarantine breakers or Orange Man supporters — for unnecessarily putting lives at risk. How embarrassing would it end up being, how damaging to our collective egos, if it is in fact the hubris we have attached to our own medical exceptionalism that ends up being the main cause of preventable deaths of this pandemic.

Thanks to CryptoNephilim on twitter.