Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Hydroxychloroquine

Episode Date: April 12, 2020

There are some pushing hydroxychloroquine as a miracle treatment for COVID-19 in a way that should seem familiar (and a little scary) to long-time Sawbones listeners. This week, we'll talk about the long history of this medicine and why promoting it as a COVID-19 cure is so dangerous to those who already depend on it for other (actual scientifically-proven) uses.Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, of misguided medicine. I'm your co-host Justin McRoy. And I'm Sydney McRoy.

It seems really unfair in this day and age. Lots of unfair about this situation when find ourselves in, the unpleasantness as I have called it repeatedly. It isn't catching on, but that's okay. I'm patient, I've got nothing to do, but wait. It's a bit of an understatement, but yeah. Yeah, it is, it is, that's fair. I wish the very unpleasantness, super unpleasant. I'll work on it. I don't know, a lot of people are calling it

the dystopian, the sickness. The sickness is like very... It's quite dystopian, yeah. It's hard to say. Charlie just says the virus, sickness is like very... It's quite dystopian. It's hard to say. Yeah, Charlie just says the virus, which is like accurate, but lacks some amount of pageantry. No, it seems unfair because I feel like I have to educate myself about something new every few days.

I used to be able to go months without learning anything and it was perfect. I'm 39 years old, I get it. You know what I mean? As far as the whole thing, life and stuff. I get it. Now I have to find myself educating myself constantly. Yes, welcome to what it's like to be a doctor. Yeah, I don't get paid enough to learn new things constantly.

Now I'm constantly like, now what is that, is that an effective? Is that good for the, what does this chart mean? I'm like, look, here charts on the toilet. I see this, this is not new to me. I, there's a lot of rhetoric in medical school. They try to sell us on this idea of being a lifelong learner. Mm.

Which sounds very exciting until you realize like, oh man, they really do mean lifelong. And it, everything keeps changing and everything's new. And then what we thought we knew we didn't we Didn't know we do now, but then it's wrong. Here's the new thing that I'm that's science man that I feel like I need to learn more about We have mentioned it briefly, but I think okay, tell me from something right is the Chloroquine nine chloroquine see I didn't even get a lot of hydroxychloroquine Hydroxychloroquine also the brand name is Plaquenil,

so you may have seen Plaquenil. Pistachia. Plaquenil. I've heard from some angles that there, it's a miracle drug for COVID that everybody should just be taking. I've heard of people taking it and well-dying from it, from taking it. Sure.

And, you know, a little bit, everything in between. So I thought maybe, and I asked you to do this a few days ago, that it would be helpful to like, have an episode, there's so much missing information out there. Have an episode to kind of like, build that base level of education about this. So we're all a little bit more discerning when we, you know, get into these discussions about this

and watch the news and et cetera, et cetera. I think it's a good thing to talk about one because it's an interesting drug, it's an interesting medication that they're all interesting to me said, don't get me started on these fascinating pills. It's got an interesting history that we can get into first. And then I think it leads us into a discussion that is relevant to the time, but it's also kind of at the heart of our show, which is we are living in a time right now where the lessons

of solbons, the lessons of medical history are so relevant and so important to keep in mind, because the soil is rich for snake oil these days. And I'm not saying. I'm going to get a lot of inkoupling out of that if you work on a little bit. I'll keep workshopping it. I'm not saying that hydroxychloroquine is necessarily snake oil, but I am saying that we live in a moment where you're going to start to understand and empathize

with all those people of the past who did things that seem totally outrageous by our modern standards. You're going to start to understand where they may have been coming from. And I think that's an important lesson to keep in mind as we move forward. Oh, empathy. It's the war you tricked me. You said I could have a refreshing cook zero if we did the podcast. You never. Oh, empathy. So you tricked me. You said I could have a refreshing cook zero if we did the podcast. You never mentioned anything about empathy.

You got to have empathy too. It's true. Sorry. So, first of all, what is this medicine? Why is everybody so excited? What do we use it? Obviously, it had a whole life before COVID. What was it?

I know from listening to you. I know it was originally an anti-malarial drug. That's right. We're gonna kind of take it. Hydroxychloroquine is like the story of chloroquine, which is really the story of quinine, which is really the story of malaria, which we've done a whole podcast on,

so I'm not gonna belabor malaria. I mean, I think it's a fascinating topic and you could do episodes upon episodes about it, but we've covered that before. So, I'm just going to focus on the parts of it that are relevant to this specific medication. As you may remember, or if you haven't listened to the episode before, I'm going to tell you, malaria used to be a scourge throughout the world. We now kind of associated with largely tropical parts of the planet, where it is still a huge problem,

of course. But it used to be a problem everywhere. It was a problem in the United States. It was a problem throughout Europe. It seems like a very common. It almost got like, I don't know if a trope can exist in the real world, but adventures and expeditions being undone by malaria is so common that it almost is like, oh great, yeah, I know malaria. I get it. It happens every single time. It malaria has been an all throughout history. I mean, the ancient Greeks talked about malaria, Shakespeare wrote about malaria, they weren't calling it malaria. You'd see it referred by different different terms for fever really, because that's the hallmark of malaria, these like, fevers that appear at pretty standard intervals and their intense fevers and

then they go away and you could see these fevers come and go and it was very scary because at the time we had no idea where it came from, why it happened, what to do about it, we didn't know that it was being carried by mosquitoes, we didn't know that it was a parasite, we didn't know any of was being carried by mosquitoes, we didn't know that it was a parasite, we didn't know any of that. So until the 1600s, our treatments for malaria were like our treatments for everything else, specifically everything else that caused a fever. Just guesses. We just guessed, and we did a lot of things that were ineffective, we did a lot of things that were messy, and we did a lot of things that were deadly, but malaria could be deadly as well.

So if you had the tertian fever, then you do what you got to do, you know. So we did a lot of bloodletting. We gave a lot of laxatives. Sure. Get it out. Whatever it's in there, get it out. Something to make you puke. We did, and then of course, we did a lot of like spells and chants and prayers and those sorts of things,

mystical thinking to try to fight malaria, as well as like gross things, like peltices and tinctures of smelly things. But it was really the Spanish conquerors returning from the Andes that took a treatment that had been discovered there by people who were native to that region, who found the bark of a certain tree was very effective in treating fevers and what they would call the shivers, which were probably like chills, wikers. So it was very effective in treating malaria, even if you didn't know, you were treating malaria.

So, and that was the bark from the synconetry. And they were using this bark, and we get into it in the episode, there's some theories as to how exactly they figured out this particular bark. Like supposedly somebody fell in, who was sick, fell in the water and drank the water, and it was bitter because the trees were growing

in that water, but then they got better, and the bitter bark from the trees, and I don't know. The bitter bark made a better. The bitter bark made them a bit better. I mean, very better. I bet the bitter bark made them a bit better. I don't have, I can't. I don't think I have anymore.

I don't have anymore. Anyway, so they'd figured out that this synchonetry was important. These Spanish conquerors found this knowledge and took it back to Europe and told everybody about it. Everybody got very excited about the bark from this tree. It would be the better bark. The better bark that made it better.

It would be many years before they figured out that it was quainine in the bark that had this effect, that that was the active compound that did this. And it was many, many more years before they could actually isolate quinine itself. That wasn't even until the 1950s, but we're getting a little head of ourselves. And even when we did, we knew that it wasn't a perfect medicine. We knew that the bark itself, if you took it in the wrong doses, if you took like the extract of the bark as it was, you know, administered previously, or quinine itself when we eventually had it, there were a whole host of

side effects and it had a very narrow therapeutic window, meaning just a little too much and you can get really sick, but not enough, and it doesn't work. And so, you know, some drugs are very forgiving. Right. Why not? It's not. So, if you took too much of it, you'd get dizzy, you'd get ringing in your ears, you could have vision changes, your heart could be really fast and irregularly. What, it still work?

Yeah, it would work, but, I mean, unpleasant. You might have a seizure or you could go blind You could die so that's one of the what one of the worst ones you've said so far. Yeah, absolutely so It's interesting because we eventually like I said piece together that it was this quinine in the bark That was responsible for all of these therapeutic effects. People started trying to synthesize quinine. Like, well, can I just make that molecule? Right. I figured out the active part, instead of having to like go harvest it from trees,

can I just make that in a lab? The first person who tried to synthesize it was William Henry Perkin, and he failed in making quinineine but he succeeded in making a beautiful purple die known as Perkin's Maw. Well that's great. He started like a whole business with this die. I'm done with trying to help people. He made a living off of this beautiful die man. Perple. Yeah. I've done wasting my time. Miss. Beautiful, beautiful lie. It's interesting because this this theme kind of continues for a while with malaria treatments. So Paul Arilik also had an idea as to a synthetic treatment for malaria. But his was methylene blue, which didn't have the same side

effects as quinine was not as consistent as in treating malaria as quainine was, but also would turn you blue if you took enough for it to be effective. That's huge. I mean, that's huge. You doesn't want to walk on the outside a little bit. A little variety. So, I mean, most people considered that somewhat of a drawback. Yes. So then, scientists at Bayer, specifically, most people considered that somewhat of a drawback. Yes.

So then, scientists at Bayer, specifically Willhelm Roll, decided that we needed a different medicine, because that one guy just made purple dye, that didn't help anybody. Yeah, funny. My mind's still making, you know, people have seizures. That got me human dye. That got blue, human dye.

That got me turned people blue. There's gotta be something better. So he made quinnacren, which was also could mepacren or adabren. And it worked well enough that it was actually like one of the predominant medicines that was used during World War II. By this point, this was like the preferred

malaria medication during World War II. However, it still did have a lot of side effects. Some of them similar to quinine. It could cause seizures. It could cause ringing in the ears. Some new ones. It could cause psychosis. It's just still a problem today

with some malaria medications. Sure, yeah. But it also, unfortunately, could turn you a color this one yellow, though. So I guess you have a choice. What is going on? We had, it took us a long time to figure out how to treat people from malaria without,

you know, like the, like Easter egg dying them at the same time. Yeah, but like, most men isn't just don't have all these like Hogwarts level side effects. Like it's like, Willy Wonka's Candid factory in here. You're just popping malaria pills and turning every color of the rainbow. It's like a skittles

that in this episode. It took us a while to figure out Malaria's tough it was tough to... I don't care. Why were the pills turning you so many different colors? It's a wild side effect to be so consistent. I mean eventually we figured out how to make a malaria medication that didn't turn people colors. That's great. That's very good. I'm looking forward to it.

I mean, yeah, I assumed. From some of the, and I'm going to, at the end of, I have the name of a couple articles I read because some were very interesting about this, but it seems like. Others. Not so. No, we're like, no, but I, I, there were a couple articles in particular that I got a lot of this information from and one in particular pointed out that there was a lot of overlap between like early pharmaceutical companies and industrial die companies, which is just fascinating. I mean, I guess like if you're a chemist, you can probably make a lot of different things. You know, I mean, you, you will apply your skills to whatever you are, you know, higher to do, but you probably can do anyway.

That's fascinating to me that people make these things. Good. All you chemists out there. You cool chemists. I'm done. Okay. Sorry. Anyway, so Even prior I didn't want to interrupt you and you're on a roll. How cool chemists and some. Anyway, even prior to World Wars, because you know there's some every episode when we compliment any group of people, we always get tweets that are like, thank you, finally. I had a guy who worked in a lab, I think two weeks ago we were talking about

how helpful lab technicians are. They're like, finally, they mentioned this for two seconds, but at least we got in there. I'm sorry, y'all are great. Everyone's great. Can I give everybody the deal? Yes, pharmacists who wrote some of these articles. People who work at the industrial dye industry,

like what's up, crushing it, I bet unless you're doing bad things in the environment, I don't know, I'm okay, it's an obsession. I don't love that. Definitely happen. I want to get probably, well, I assume. I don't know. I don't know.

Probably, anyway. So Chloricwin had actually been in the works happen. I don't know. I don't know. Anyway, so Chloroquen had actually been in the works at Bayer even prior to World War 2. So even as they were giving people this quinnacran that turned them yellow, they had Chloroquen. Now they initially thought, and this was like a big mistake that they would realize later, they thought it was too toxic to give to humans. And so they had just kind of shelved it and hadn't even considered it. But in light of all these other medications that did a lot of things that people would prefer they didn't, they went back and took a second look at it after World War II and went,

well, you know what, actually, this was actually a pretty decent medicine. There were some side effects, but it didn't change you blue or yellow or any other color. So that was nice. And a lot of the other side effects, I had were similar to these same meds and somewhat less so, so why did we not give it a chance? So over the next couple decades, it became very popular as an alternative to these other medications that you know Turned you blue and whatnot and and eventually they added If you know chemistry all they had to do is tack on a hydroxyl group to one of the rings to make a hydroxychloroquine

Chloroquine hydroxychloroquine. Yeah, sure anyway. That doesn't really matter the point is what that did was make it even better tolerated That was that was basically the idea there. So now we have this great malaria medication, hydroxychloroquine, that I, did I take that or chloroquine? I've taken this before. Because you can, I mean, we still use this medication today. It's an option not all over the world because it depends on if there's resistance in the malaria of that region because malaria has gotten smarter through the years and is resistant to some of these early medications, specifically Chydroxychloroquine in some parts of the world, but I believe when I I believe when I went down to Central America I

was able to take it. But anyway, so we still use it today, still a worthwhile medication. It's interesting in that if you want to know the mechanism of action, I might do. Of course. We don't know exactly how it works. Fun. We have some ideas as to what it does inside the malaria parasite, but we're not entirely certain.

We have some theories and like there's some things we're pretty sure that it definitely is doing, but as to every all the little teeny tiny molecular reasons as to why it does what it does, it's not completely understood. But we have this medication, it works from malaria and back then when we get a new medicine and it does something. We use it for everything. We try it for everything else. I want to hear all about that.

Well, I'm going to tell you about that Justin. First, let's go to the billion department. Let's go. The medicines, the medicines, the ask you lift my car before the mouth. Sid, we got this great new drug. I wanna pitch you on it. It does something and doesn't change your color.

And I wanna put it in production for everything. I just wanted to take it, put it through its bases. Let's get trying it. So let's do it. So we've got chloroquine, hydroxychloroquine now. This is great. We're using it from malaria so that we don't have to either go harvest tree bark every time we want to treat malaria.

We're turn someone yellow or blue. And that's great. So why don't we try it for other things and see what else it's got up at sleeve, so to speak. And this was common practice if you look back to like the late 1800s and early 1900s when you find a new effective medication, similar to what we've always done, right?

With medical practices like bloodletting. We used it for everything, mercury. We used it for everything, because that's what we we had. Anything that did anything was better than nothing or at least so we thought that's not always true. So we still do that is that how we found out stuff like well you true and helps you quit smoking that kind of stuff. No not not exactly like that. We we have reasons why we would try something for a new application. Like we would see properties in the medication that might make it useful for a different condition.

Or- We understand the neurochemistry a lot better to these days. Precisely. The mechanism of action and all that is so much more well understood, especially a drug that's developed as opposed to kind of going back the other direction and taking a drug. We don't know why this worked. We just made this thing and it seemed to work as opposed to this was designed to do this. We also noticed things in clinical trials.

Like, we did it to see if it would have this effect on humans, but as we were doing the study, we observed this other effect it had. And so that's where you find some of these, like you said, with well-buterin, also being used for smoking cessation. That's where you see that is in the study they found that a lot of people quit smoking. I'm overwhelmed that I'm married to such a smart person. Sometimes it just hits me. I love you so much. Well, thank you. Sorry, go ahead, continue. Well, thanks. I didn't

mean to interrupt. Please go on. So we figured out we want to try for everything. It's the point. So at that point, when you talk about things like lupus or rheumatoid arthritis, we didn't really have great medications at that point in history for these conditions. And so the this these medicines hydroxychloroquine, or it was tried for those conditions and they saw a response. And it turned out, you know, it's always interesting. If you look back, you'll see that like, well, we tried it for this and we thought it worked. And half the time we were like, no, that actually we just, it didn't work. We just hoped it did. It did. I mean, there, there are definitely were effects. And to this day, it remains an

important treatment for these conditions. There, of of course are a lot of other options as well, but it still is used as plack one ill, hydroxychloric one either way, whichever one, whichever you want to call it. We know again why does it do this? Why is it so effective for these conditions? We don't know. We're still not entirely sure. We know it has something to do with the inflammatory response. It has a way of

suppressing the inflammatory response that is so central to Lupus and rheumatoid arthritis and other, you know autoimmune conditions and so but it but as to the exact mechanism of action We still don't know which is important to know that if anybody tries to tell you they know exactly what it's doing which is important to know that if anybody tries to tell you, they know exactly what it's doing, hopefully in patients with coronavirus, we have no idea when we don't know. Again, it plays into this idea. We know that it has some effect on the inflammatory pathway.

There are a lot of different things we've observed that it could be, I could get into the biochemistry of what it could be doing, but again, it's still, we're still guessing somewhat. So it became very popular. And occasionally we would find that because it was so popular, doses of hydroxychloric and quinthorout time have been pushed too far.

And so we know the dangers of this medicine because we've seen, you know, patients have these side effects. It can cause retinal toxicity resulting in vision loss. of this medicine because we've seen, you know, patients have these side effects. Right. It can cause retinal toxicity, resulting in vision loss. Again, that's usually chronic use, but it can do that. There are also irregular heartbeats, arrhythmias that are associated with hydroxychloroquine.

And we know because we've been using it for a long time. For rheumatoid arthritis specifically, the real breakthrough for hydroxychloroquine was actually when we found newer meds, other meds, methotrexate and sulfosalazine that we could combine with it, and we could see a huge effect from that. So it's used in a lot of combos and things now.

And over time, we've seen some other positive things from hydroxychloroquine, like in rheumatoid arthritis patients who were on it they had fewer cardiovascular events like heart attacks things like that and they had a lower rate of developing diabetes why I was about to ask you why I bet the answer is well we're not again it probably has something to do with all these inflammatory pathways that are happening. It's not understanding the mechanism of medicine. I don't want to say, I mean, it certainly happens.

I mean, this is not the only medicine that we're not sure exactly how it works. It is not alone. That's why. Again, more and more, we're designing medications, right? I hope you know why those were. So, yes, we're more likely to understand exactly how they work if we, but there are a lot of medicines that have been around and worked well for quite a long time and

We don't want to stop using them because they work. We know they work. We've put them through their paces, but what You know sometimes it was luck that led us to them in the first place Really really scientific, scientific luck. I don't think somebody with a brain. I don't think- Somebody with a brain problem. I don't think a guy falling into a scientific look to be fair. No, but the synthesis- Unless he was doing some like astronomy or something, it just wasn't looking great as going. The synthesis of chloroquine and hydroxychlorine and all that,

that's scientific look. You know, I mean, somebody knew what they were doing when they made these molecules. Maybe they didn't exactly understand why. But for lupus, it's still a good choice. It can reduce the number of flares of lupus. It can reduce the severity of flares. It has a lot of, suffice to say, it has a lot of positive effects in lupus patients.

And there are other medications too, but it is a good choice for a lot of patients with lupus. There are no studies that have been done on it specifically on pregnant patients, but it is felt to be a safe medication to take while pregnant. And that's common when it comes to medicines and pregnancy, as you may imagine, doing a study on pregnant people is not. Huge, really popular. Right, I mean, you know, it's very hard to say, I want to take a randomized group of pregnant people

and give some of them a medication and others not and see what happens to them. Right. No. Which is why we, a big part of the reason it's so hard for us to say which OTCs are, sorry, over the count of medications are like safe for pregnant women to take because no one wants to be the guinea pig and fetal guinea pig within said guinea pig on that on that particular precisely. So we don't have the same rigor of evidence for those kinds of things. We have a lot of history like anecdotal evidence to say we know for a very long time this medicine

appears to be safer, but it's hard to have the degree of certainty, but it seems to be safe in these patients. And the reason I'm telling you all this about it is that it's hard to have the degree of certainty. But it seems to be safe in these patients. And the reason I'm telling you all this about it is that it's a very important medicine for some people. And I think that's key to understanding all of the pieces of this story today. This medicine is, you know, it's life-sustaining, life-saving, it's quality of life saving. It's important for people with conditions and we've known this for a long time. Yes, there are other options for malaria. A lot of people say that well, there are other drugs for malaria. Yes, of course, there are other

drugs for malaria. For some lupus patients though, this medication has changed their lives and it's a big deal for them to not be able to get access to it. So it's a point I want you to understand about hydroxychloroquine. It has a place, it's listed as one of the World Health Organization's essential medications. So we should, if we can, keep a steady stock of it for the patients who need it. Obviously, there are still risks, even now taking it in the appropriate doses and all that kind of stuff, but it's still a good medication. So again, how does it work now against COVID-19?

Okay. Yes. Because these call it by coronavirus. Yes. Well, we don't really know. I should have guessed that actually. Again, something with inflammation is a theory, of course, because we know it works on these other inflammatory conditions and we have seen that in the severe cases of

COVID we appear to have what is being called the cytokine storm this big inflammatory reaction. Yes, that causes some of the very severe complications and the mortality and so does it have some impact on that? and the mortality. And so does it have some impact on that? There's also thought that it can help prevent the virus from entering cells. And so is it, would it be better to give it to people as like a prophylactic? Like should we be giving it to healthcare workers

who are being exposed to the virus on a regular basis? There's been some thought about that. Again, these are all things that have been observed in labs and are theoretical. Yes. But they're not proven. They're not proven in any way, shape or form. There's been some thought, does it have something to do with zinc? Does it bind zinc?

And that's why it does that. And it does bind zinc, but does that have any effect in a human body? No, nobody knows. In terms of studies, there have been, I mean, this isn't evolving. This is, it is April. The, 12th. We've only been dealing with this on a global scale

since December. Right. So, it's impossible for there to be good solid studies on anything at this point. It's just there isn't enough time. You couldn't have done it. There have been very small studies in China and Italy and France and now there are big studies or they're they're putting together larger studies in the US, but they're still, I mean, in the early stages. Right. To look at the effect specifically of hydroxychloroquine,

as well as hydroxychloroquine plus azithromycin, which is an antibiotic that many of you probably know as a Z-PAC. Oh, right. You heard of a Z-PAC? Yeah, this is very common. This is azithromycin. That's what they're talking about.

The combination of these two is thought to perhaps be more effective. But all of these studies that have been published don't hold up to our typical scientific rigor. And the results are mixed at best, even when they show some positive results, they're fairly modest. There's problem with how many patients, they're all

fairly small. Some of the studies don't have a control group, you know, a group of patients who didn't get the medication, which is necessary for a decent study. Some of them have not been blinded, which means the doctors know which patients got what. Oh, that's not great. Some of them have not been randomized appropriately. And one of the main French studies that you may have heard cited, if you've been watching any press conferences recently, has actually since been retracted for not meeting appropriate standards. That doesn't mean that they lied or anything.

I'm not saying that, but it did not meet. I think it's important to know before when researchers decide to do a study. First of all, you're supposed to get it approved. So you write up a proposal and send it to a review board to say, is this fine? Is this okay? Is this okay to do? And once you do that, then you do an appropriate study,

and then you write it all up and send it to journals to be published and it's reviewed by peers like other members of the scientific community to look at how did you go about it, what were your methods, what statistical analysis did you use, what were your conclusions, and does all that make sense as a scientist, does it make sense? Not, does it say what I want it to say? Right. Does it make science sense? And only then should it be published. If your peers agree, yes, yes, this makes science sense. Right now, what's happening is stuff is being published that is not going through that process. Because we're in such a hurry to get it. Yes. So you were hearing

and I think because if you are not in the scientific community, if you're not used to reading studies, it's all coming in at the same volume. You know, I mean, we heard news reports before COVID of the newest scientific study suggests that blah, blah, blah, coffee is good for you or bad for you or whatever we decide coffee is today. These are coming in with that same kind of level of certainty, but it's not in any way representative of the usual scientific rigor that goes into this process. So any study you've heard about hydroxychloroquine, it's, I mean, it really... chloroquine, it's, I mean, it really... Specific to co-cove, I mean. Yes. We have no idea.

We have no idea. A lot of the stuff is working in a lab and not necessarily in humans. And we've talked about this before. Stuff that works in vitro, in a lab, does not always work in vivo in humans. If that were true, we can dump bleach on germs in a lab and kill them, we can't drink bleach

as we have covered in depth on this show. Yeah, so more than we should have honestly, it should have had to. It's not one to one. And in times like this of crisis and panic, scientific rigor and ethics will easily be tossed out the window if we're not careful. If you look at the heroic era of medicine, which we've covered on the show many times, at that moment in history, we just, we knew enough science and enough stuff to feel like

we had a grasp on it. And so our theory when it came to treating people was, look, you've got something that I sort of understand, but not really, but I do know it will kill you. So anything I do is worthwhile because you're gonna die anyway. Right. So now.

That's the heroic era in a nutshell. Exactly. So now let me give you mercury. Now, let me do bloodletting. Now, let me blister your skin to heal your infections. Let's do trepination. Let's do a lobotomy. All these things were justified in part by saying,

well, it's better than nothing, right? Right, right, right. You're gonna die anyway. Might as well give this a whirl. Yes. And it's important to know Might as well give this a whirl. Yes. And it's important to know that that's not how science works. That's not the level of professionalism. And those aren't the standards we have held

our medical scientists to ever before. Like we deserve better than that. We deserve more than that. Hydroxychloroquine may, after appropriate study, show some effect on COVID, but as of now, there's no compelling evidence, really. It's just not there. Again, I'd be great if it was.

I hope that one of these medications that are under investigation will show something. Okay, for everybody. Right, I mean, right now, my personal greatest hope is on a vaccine, which is going to take time again because we want it to work and not hurt people. But if one of these other medications turns out to be more effective in treating patients or preventing infections, that would be amazing.

That would be wonderful. I think it's weird to see If you push back against hydroxychloroquine as a miracle drug People say well, you just don't want anything to work who wouldn't want we all want something to work Of course, I want it to work. Right. Of course. I would love for it to where I would love to see studies that showed these things work They're they're just not out there right now. Yeah, they're still they're still doing studies, they're still figuring things out, but it's just not out there yet. But we do know that it helps people with lupus and rheumatoid arthritis, and some of them

need it. Right now for sure, guaranteed. It definitely works for that. And when you get it, however, people get meds that aren't being prescribed to them. Or when you harass people to prescribe it to you, or when you are a prescriber who starts giving it out to friends or family or neighbors or whoever. Just for the heck of it, just in case. Just in case, it's irresponsible and it's reckless because it hordes the medication and keeps it from people who definitely need it.

It also makes it harder for if we are going to do these trials and we are going to give it to patients who are already hospitalized and perhaps severely ill, it makes it harder to get there. Yeah, there's no, I mean, it's a loser. I understand the idea. And it's also like, you've covered it. It is not up like a fun drug that you can kind of like mess around with a little bit and take and maybe something good will happen,

maybe something more. No, it's not benign. As you may have seen, it can cause change in the rhythm of your heart, a change in the electrical conduction of your heart, something we call, you'll hear us call Qt pro-longation. And what we're actually talking about is not your heart, we're talking about the EKG, that we look at, that tells us the electrical, like that we look at to see

the beat of your heart that we read. We're talking about a specific segment of it gets longer, a segment we call the Qt segment gets longer and that can be when we start to see that on an EKG, it's a warning sign, it's a big red flag to us that, if this continues to get longer, you're at risk for a deadly arrhythmia that can kill you. And Azith or Myeson, the Z-Pack can also do this. So if you take them both together, unmonitored, it's a bad scene. It's a very bad. Somebody's going to get harmed and someone has already died after taking some sort of, I think it was like a aquarium, a aquarium, something, yeah. The contained chloroquine as a way of trying to prevent them from getting the virus. So you can't just put these ideas out there without appropriate scientific backing.

We need to tell people the truth. We need to be transparent. When things work, they need to know. When things don't work, they need to know. When there's uncertainty trying to push people on a medication that is unproven It's false hope and while hope is wonderful false hope is worse than nothing at all It's a well and especially like this when it's hurting people I mean we talk a lot on the show about like if it doesn't hurt you if it in other people

And you know, you're not losing money on it, go for it. Like give it a whirl, see who knows, maybe it'll work for you. But this is like every time you buy this in order, you're like keeping it from you that actually need it, it's ridiculous. And I'm seeing a lot of this, not just throughout the lay community,

but throughout the scientific community too, a lot of people are scared, and a lot of people are forgetting the things that they've been taught in school when it comes to the scientific method and the way we go about things and the reason that it is it's frustrating how long sometimes it takes to prove that something works or doesn't work but that process is there for a reason and ethics tells us you can't just throw it out the window because you're trying to be expedient,

because you will harm people. Right. And right now I would be very cautious. You're gonna see a lot of articles, especially on social media and stuff, that will try to tell you that there's this secret wander drug. And I've seen these protocols.

They're not always advertised, like they would be to the consumer. I've seen them... That look called doctorate? Yes, they're trying to sell them to me as a medical professional. And if you listen to this show, you know that right now, no matter how smart and advanced we think we are, this is a time when snake oil will be rampant. And you just need to, if you talk to your doctor, you know, talk to medical professionals, make sure that the people you're listening to, or the people

who are actually, you know, reading the studies, finding the evidence, doing things the appropriate way. Yeah. And not a Facebook post. Thank you to Martin J. Bergman and Derek Lowe for the articles that were fascinating on the subject of Hydroxychloroquine and the history and all these dyes and turning people different colors. Yeah, I hope you bookmark those bad boys because I would love to dive in as soon as I get a little free time. I feel like you're giving me a hard time. Thank you so much for listening to our show, Sobuns.

We hope you've enjoyed yourself. Hey, if you need a little reading material right now, maybe hop on over to buy a copy of the Sobuns book. You can go to bookshop.org and it'll help you find a local bookstore where you can shop online and get it sent straight to you. We don't know if it pays us to say that. I just think it's good service. Thank you to the taxpayers for using their tongue medicines as the Intro and Outro program.

And thank you to you for listening. I hope you're staying safe. Hang in. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in there. Hang in just keep your chin up and hang in there. That is going to do it for us for this week. So until next time, my name is Justin McRoy.

I'm Sydney McRoy. And as always, don't drill a hole in your head. Alright!