Post #742: I guess I should comment on hydroxychloroquine

Posted on July 3, 2020


You’ve probably seen news coverage of the Henry Ford Hospital study.  They showed that if you gave people hydroxychloroquine early in their COVID-19 hospitalization, it materially reduced the death rate.  This is apparently a different study, but similar to, the one that I referenced in Post #701.  This one provided hydroxychloroquine early in the admission.   The other combined it with zinc sulfate.  And these studies appear to contradict some earlier studies showing no benefits from hydroxychloroquine.

If you want a brief summary of all the reasons that hydroxychloroquine was a good candidate for a drug for treatment of COVID-19, see Post #701 I won’t repeat all that here, except to say that it has nothing to do with the President.

It is worth nothing that neither of these studies is a randomized trial.  Instead, both of these study cases where physicians chose this mode of treatment, versus some other mode.  Many, many things can go wrong with observational studies of this type.  It’s also worth nothing that the study that got the FDA to rescind emergency approval of use of this drug was, similarly, a study of observation data, not a randomized trial.

Of some interest, both of these studies seem to show that, when given in this way, hydroxychloroquine roughly cuts the mortality rate in half.  That is, the “effect size” appears to be about that same in this Henry Ford Hospital study and the study I cited earlier.  That’s encouraging, because it suggests (but does not prove)  that they are looking at something real, and not just an artifact of the methods.

And, although mortality rate is the only clear endpoint reported for this study, it’s a fair guess that all the other endpoints are affected as well, such as being discharged to home (versus discharged to post-acute care), use of a ventilator, and so on.

As a long-time consultant to many health care manufacturers, including drug companies, let me point out one thing:  Hydroxychloroquine is CHEAP.  How cheap is it?  Try $0.73 per pill.  Call it a buck and a half a dose.

As long as it has minimal side effects, when given as it was in this study, it would have to show only the slightest beneficial effect to be a completely cost-effective treatment.

Contrast this to remdesivir, an anti-viral with some modest effect on improving outcomes of some COVID-19 patients.  (Let me emphasize, modest improvement in some patients.)  That’s been announced at about, oh, call it $3000 per patient, more or less.

But that’s a bargain compared to yet a different biologic, canakinumab, currently being tested for COVID-19, which apparently costs something like $17,000 per dose.

And, here’s what you need to know about U.S. health care.  When either of those expensive and possibly-somewhat-moderately-effective drugs gets approved for use in treating COVID-19, physicians will have no choice but to prescribe them.  As long as there’s no plausible alternative treatment that appears to work as well.  So, they’ll prescribe them, or get sued by the families of patients who died, if they didn’t prescribe them.  And the physicians prescribing those drugs typically have no stake whatsoever in what those drugs cost, and most commonly would not even be aware of the cost of the drugs they are prescribing.

Because when it comes to health care, it’s all about spending somebody else’s money.  Health economists have a term for it — moral hazard — but that’s the bottom line.  So if you’ve ever wondered why health care in the US is so expensive, and why it consumes one dollar in eight of the US GDP, just think of this example.

This, for an illness that may soon flood hospitals in certain states with new profit opportunities cases.  Frankly, I’m amazed that hydroxychloroquine has gotten this far, given that nobody’s going to make any money off it.  Normally, if you can’t make good returns, nobody has any interest in investigating a drug.  Which is why the only drugs being developed are the hyper-expensive ones.  Here, it took a deadly pandemic to stir interest in this half-century-old generic commodity drug.

No clue what the ultimate outcome will be.  But for sure, the big money is pushing the big-money drugs.  That’s not in the way of blaming them, that’s just in the way of understanding what businesses do.  I hope that Henry Ford and other charitable institutions will continue to investigate this drug.  Because if they don’t, it’s an excellent bet that nobody will.  For the simple reason that nobody can make a buck off it.