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Plaquenil (or why we must test, test, test)

Every day I take a drug called hydroxychloroquine. If that names sounds vaguely familiar, I'm not surprised. It was highly hyped in all sorts of places (along with azithromycin) as a potential wonder cure combo for the Covid19 virus. On the interwebz I saw any number of non-medical "experts" citing arguments for its purported benefits. Among them:

The "common sense" argument - it has been hypothesized that the Covid19 virus might invoke a serious immune response (known as a cytokine storm), which has been attributed as a possible cause for why some people get sicker than others. Individuals with autoimmune diseases take Plaquenil because - for reasons that remain unknown - this antimalarial drug can suppress some or all of this activity, thus stopping the immune system from attacking joints and organs. So, if it works for that ... hey, why not?

The "they did a study" argument - actually, it was two studies in France and one in China. Researchers for these studies stated they found that the combination of these drugs produced positive results in patients hospitalized with the virus. However, as other scientists were quick to observe, each of these studies had significant methodological problems that rendered the results unreliable as a base for clinical decision-making and/or public policy. Here's what Science Magazine had to say about this:

Despite the plethora of actual experts warning people against taking lousy medical advice from non-medical experts based on shoddy research, media reports quickly highlighted public demands for the drugs. Hospital staff were cited as having to tell people that no they could not demand this treatment, and pharmacists cited a run on Plaquenil in US pharmacies, as people sought to take it as form of prevention*.

Fast forward a couple of weeks and here's the headlines:

"French study finds hydroxychloroquine doesn't help patients with coronavirus"

"Small Chloroquine Study Halted Over Risk of Fatal Heart Complications"

"Study finds no benefit, higher death rate in patients taking hydroxychloroquine for Covid-19"

Fill in the Blank:

In short, the cautious approach taken by scientists who argued for well designed and well executed randomized controlled trials in order to verify claims these drugs work for successfully treating covid19 cases turned out to be ___________

a. prudent

b. wise

c. correct

d. all of the above

e. really? you're still looking for another answer?


What has all of this to do with policing research you ask? Well, lots. Think of all of the times that -- on the strength of one study and one study alone -- a police agency decided to invest time, money and resources into a program, policy or practice (or not). Off the top of my head I can easily think of one particularly atrocious example, and I'm sure you, dear reader, can think of some too.

One of the fortunate aspects of this practice in policing is that the potential backfire effect of rushing off based on one single study doesn't typically involve people dying because they drank fish tank cleaner. That said, there can be both individual, group and social harms as a result of well-intentioned programs built on a flimsy evidence base.

Cast your mind back to that ridiculous program you thought of, the one that was implemented simply because "Kansas City did it and their stats looked good", and ask yourself: did the benefits achieved outweigh any potential harm? Were potential harms identified? Were they measured? Were they addressed and the fixes tracked over time?

At the risk of repeating myself - and keeping in mind that I'm old and we tend do that sometimes - it's important to emphasize that the BASE in evidence BASED ought not refer to a decision based on a study. Or group consensus. Or expert opinion. Or what Kansas City did. It ought to refer to the results of multiple careful studies, conducted independently, rigorously, and in as many different contexts as possible. In other words, if you want to increase your odds that something will actually work, you test, test, test ... and then test again.

*I'm not sure whether the idea was that the drug would have some type of prophylactic effect thereby stopping one from getting the virus, or whether the intent was just to prevent symptoms from getting worse. Although I am dedicated to science, I am not that dedicated and there are some places I simply refuse to go. One of those is anti-vaxxer websites, another is places where people dole out dangerously stupid non-expert medical advice. Actually ... I suppose those are the same thing. Let me try another one: I refuse to delve into this stuff for similar reasons as to why I will not be watching The Tiger King. There are limits to what I'm willing to do to observe a train wreck.


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