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.
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.
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.
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.
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