The Homa Files

Yesterday, I gave readers a gut-check question:

If an elderly loved one was hospitalized with COVID, would you advise them to try the HCQ-combo, or tell them avoid it like the plague?

I got an interesting challenge question from a reader:

Prof. Homa, My gut question for you, with all the hypothesis and analysis, are you comfortable taking the combination as a preventive measure like Mr. President is doing?

It’s a good question. One that made me think harder about the HCQ issue.

Here’s my answer…

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First let me lay out a couple of my decision-making principles:

• He who acts as his own doctor has a doctor who is a fool
• Fewer meds are better than more meds; generally, no meds beat few meds
• Each individual has their own risk-tolerance
• Context matters: it all depends on situation-specific variables.

Regarding context, in my case:

• I classify as “vulnerable” by age, but have a favorable health record (no co-morbidity factors, historically strong immune system).
• And, I have taken sheltering in place very seriously — few trips out of the house, virtually no contact with anybody but family (whom I’m confident are are not infected).
• Though I haven’t been tested (I don’t qualify for a test under Maryland’s rules), I’m confident that I’m not infected.

So, to answer the specific question that I was asked,  I would not take the HCQ cocktail (HCQ + azith + zinc) now.

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Change a few of those contextual factors and I would most likely opt for the HCQ cocktail.

For example, if I was working in an office and I had been exposed to one or more co-workers who  tested positive, I would seriously consider the HCQ cocktail (70-30 likelihood) as a preventative measure.

Ditto if I had  inadvertently been exposed in a hostile coronavirus situation, say, a grocery store that subsequently reported an outbreak among its workers.

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And, the likelihood of my taking the HCQ cocktail would  approach certainty if either:

(1) I tested positive for coronavirus, or

(2) I had coronavirus symptoms — regardless of whether I tested positive or negative (given the  high rates of false negatives that have been reported and have not been adequately refuted by the gov’t scientists)

WSJ Shocker: 1 in 3 infected patients gets a ’false negative’ test result.     

Dr. Birx was asked about the reported “false negatives”

In either of these cases, I would aggressively prompt my doctor to prescribe the HCQ cocktail (95-5 likelihood) … with the only uncertainty being a revealed risk factor that I hadn’t considered.

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How do I reach that last conclusion?

First, we have to make time-essential decisions based on the best information that we have at the moment.

While I’m a data geek, unlike Dr Fauci, I’ve developed a complementary appreciation for anecdotes and intuition … especially in novel and highly uncertain situations.

In such situations, I disagree with the popular wisdom that “the plural of anecdotes is not data”. I believe that the plural of anecdotes is, in effect, data … provided that there are enough of them, that they are generally consistent and that they have plausible rationales.

The power of anecdotes 

The plural of “anecdotes” isn’t “data” … or is it?

I also believe that intuition is not a pejorative term that necessary;y indicates shallow thinking or reckless “flying by the seat of one’s pants”.

Rather, I’ve concluded that intuition— which I define as subconscious thinking based accumulated education, experience and emotions — is a valuable decision-making tool that facilitates a subjective consolidation of factors — some of which may be imprecisely measurable.

When can you “trust your gut”?

Finally, long ago, a wise manager once advised me to “focus on the upsides and downsides … the stuff in the middle will take of itself”.

At the time, I dismissed the advice as too simplistic. But, over time, I concluded that the guy had, indeed, cut to the chase … and, I often resort to that decision-making heuristic.

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OK, let’s apply the principles to HCQ.

WARNING: I’m neither a scientist nor a doctor.  And, I don’t offer medical advice. Period!

In my opinion …

• There are enough practicing physicians who claim to regularly prescribe HCQ to COVID patients with a high success rate.
• While there haven’t been any Fauci-approved double blind controlled clinical tests, there have been several observational reports (e.g. the recent NYU study and studies Didier Raoult, a French infectious-disease specialist). In combination, I find them to be directionally compelling.
• While some studies (e.g. the Cuomo reported NY test) have concluded that HCQ offers no discernible benefits, they did not report any significant hazards.
• The only significant downside reports have isolated coronary risks (e.g. arrhythmia) to patients with going-in coronary vulnerabilities.
• There is a long history of millions of patients taking HCQ for other indications (anti-malaria, lupus, rheumatoid arthritis) with relatively few, relatively minor side effects.

So, intuitively combining this anecdotal evidence and applying it to my specific context and risk-tolerance with a sharp focus on the upsides & downsides…

I would not take the HCQ cocktail now, but I would if I had been substantially exposed to the virus .. or if I tested positive … or if I had coronavirus symptoms  (regardless of whether I tested positive or negative).

That’s my personal decision calculus … not medical advice to anyone else.

If you (and you doctor) read the data differently or if you have a different risk-tolerance than I do, then do not  even consider taking the drug and advise your friends & family accordingly.

It’s as simple as that….

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P.S. Since Trump is age-vulnerable and there has been a viral outbreak in the White House, I think his doctor-approved decision to take the HCQ cocktail as a preventative measure makes total sense.

This entry was posted on May 20, 2020 at 10:30 am and is filed under Coronavirus - Covid 19. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.