The Controversy on the Effectiveness of Hydroxychloroquine / Azithromycin to Treat COVID-19

by Jacques Pollini, PhD, Research Associate, Department of Anthropology, McGill University

Note: the French version of the article is available at this link.

A surrealistic controversy is taking place, globally, about the effectiveness of hydroxychloroquine and the combination hydroxychloroquine/azithromycin, a treatment developed by Professor Raoult at IHU Méditerranée Infection in Marseille by repositioning cheap drugs to treat COVID patients at early stages of the disease. On one side, medical doctors prescribe these molecules, separately or in combination, and observe they heal their patients. On the other side, governments and the experts who advise them, in France, Canada, the USA and elsewhere, say hydroxychloroquine should not be prescribed, argue it’s dangerous, and recommend medical doctors to only give symptomatic treatments like paracetamol to non-hospitalized COVID patients,. Retrospective studies and a few randomized experiment attempt to bring definitive conclusions about whether this treatment is effective but are immediately criticized for lacking rigor, not addressing the right question, or using fabricated data, some of them being withdrew by the authors or publisher. The implication of this controversy is enormous, since if the hydroxychloroquine/azithromycin treatment works, that means the risks of severe disease and death are extremely low and possibly negligible, except for elderly and vulnerable persons, and that it is thus unnecessary to keep everybody in confinement. Prevention efforts could then focus on aged people and the economy could continue to work. 

This piece reflects on that controversy. I argue that many are loosing their common sense in the debate and that until the results of reliable randomized trials are available, which may never happen or happen too late, the best available data to be used to decide how to treat COVID is that provided by the medical doctors confronted with COVID patients. All testimonies and data sets available, the main studies being reviewed in a recent publication, converge to saying that when the combination hydroxychloroquine/azithromycin is given to COVID patients at early stage of the disease, it significantly reduces time for healing, risk of aggravation and hospitalization, and risk of death. I further show that studies that conclude that these molecules do not work address the wrong question if the purpose is to address this controversy, since they are all conducted on severe patients for whom almost nobody said the therapy would give good results. Moreover, they are not randomized either. They are nevertheless used to discredit the treatment, revealing the bad faith or the incompetence of their promoters. I explain that strange situation by the influence of pharmaceutical lobbies, for whom developing and selling a new drug protected by copyrights to treat COVID patients would be source of high profits while the repositioning of old drugs would destroy that opportunity. But I don’t interpret this as some sort of evil global conspiracy. Rather, I believe that most of those opposing hydroxychloroquine/azithromycin are in good faith but are trapped within a view of the situation that, once established by small influential groups and given the authority of “science,” cannot be escaped without experiencing a painful cognitive dissonance, that is, a deep discrepancy between our belief of what reality is and our direct observations of what it actually is. We now need to be ready to experience the pain of this cognitive dissonance, reflect on our errors, repair the damages of unnecessary life losses, and put into question our narrow conception of what science is. 

The COVID battleground

I will start with a metaphor in an attempt to bring the reader back to seeing the situation as it is: a real-life challenge that has to be addressed quickly and collectively; not just a scientific question that highly educated statistician alone could answer. A real-life situation to which are confronted million patients and their medical doctors, with the need to produce an answer now, implement that answer and face the consequences of their decisions; not just publish definitive proofs or treatment efficacy in scientific journals. In that metaphor, I will call the virus “attacker”, and the treatments “bullets”, as a reminder that in infectious diseases, to find a cure mostly consists of finding an agent that kills the pathogen, contrary to diseases like diabetes or cancers, where things are less straightforward. I will call the medical doctor “shooters,” the randomized trials “tests”, the placebo treatment “blank bullets”, the retrospective studies “counting of deaths”, and the decision makers, be they political leaders or the administrations that manage the healthcare system, “Generals”. The “cytokine storm”, an inflammation of the immune systems that is a late stage of the COVID-19 disease and causes death even though the virus is not anymore in the body of the patient, will be called the “zombie” stage. And since we are “at war,” as French President Macron stated it six times in his first nationally broadcasted speech on COVID-19, the scene will take place on a battleground.

Imagine you are under attack and a few guys around are shooting to defend you. They use different kinds of bullets. One of them shot 6 attackers and all fell dead according to the shooter, although a guy who saw the scene says it’s only 5. The other defenders use a different kind of bullet and don’t have such a success. Many attackers, oddly, fall on their own, but not immediately and they can still harm before they fall dead, that is, they can contaminate people who then become carriers of more attackers. Another odd thing: after a while, attackers turn zombies and then they can’t be shot anymore with the bullets available. Before turning zombie, they can also be very strong and the bullet is not enough to kill them. Thus, when they have turned zombies, they have done a lot of harm already, and since nobody knows how to kill zombies, you need to shoot the attackers before they turn zombies and before they get strong and contaminate many people. 

Once you figure out that situation, of course you are going to ask the guy who seems to kill his target most times: what kind of bullet do you use? Get more of them for us! Problem is the General who coordinates the defense says to everybody: 

“Sorry but this bullet is not approved. I want to be sure that this bullet works, and that it’s not dangerous, by comparing it with others and with blank bullets in a test before we use it. Maybe the bullet does not work and you were just lucky, so please wait for the approval of the bullet. Don’t worry, I handle things meanwhile.” 

Being the person attacked, you are angry and think this is nonsense. You think you should just continue to use that bullet and that if the shooter was lucky, luck could not last forever and you will eventually figure out if the bullet is not good. And you are angry because you know this bullet has been used million times before and you know it’s not dangerous. True it was not used for the same kind of attackers so something new could happen, but you monitor closely the battle and would notice if bad things happened with that bullet.

This is the situation we were in March and the attacker is called Coronavirus SARS-CoV2. When he hits you, you get the disease COVID-19 and you become yourself a carrier for attackers. The bullet that killed 6 attackers with apparent success is called hydroxychloroquine/azithromycin. It is cheap and can be easily manufactured in many labs in the world. The General who said the bullet should wait approval through a test, that is, a clinical trial, is the FDA. Generals have this way of thinking when they are not on the front. They turn bureaucrats unable to see things from the perspective, pragmatic, of medical doctors and patients. Generals in France, Quebec, and Switzerland just took the same or similar decisions. The 5 or 6 attackers who fell dead are coronaviruses SARS-CoV-2 in a battle that took place in Marseille, where this bullet was designed and used for the first time, although a similar bullet called hydroxychloroquine had been used before in China. A report of this first battle in Marseille was published in March 2020. After that, the people in Marseille continued to use that bullet, to check if it is dangerous, and 99% of the attackers fell, according to reports of bigger battles issued in March, April and May. For the 1% attackers who did not fell, it’s possible that several had already turned zombies. At least, they were very severe strong attackers close to turning zombies, so it was not a surprise that the bullet did not work in their case. It’s not a magic bullet and nobody ever said it was. It just seems to be a good bullet and like any bullet, it has to be used in the right way, before attackers get strong, to be effective. And it doesn’t kill Zombies. You need to find a different kind of bullet to kill these zombie guys. 

Then many people started to shoot with the same hydroxychloroquine/azithromycin bullet in other battles. Some kept record of their success, like these shooters in New York City, Texas, Brazil, Italy, and France. True, we will never know how many targets these bullets killed exactly. Some of the attackers could have fell on their own, or the bullets could have been used only on the easiest targets. In theory, it’s possible that these bullets actually don’t work and that attackers fell for other reasons. But that’s only theory and it’s not what experience and practice say. With all these battles that have already been fought, you have to come to the preliminary but quite solid conclusion that the bullet works, unless you consider all the shooters are cheaters and liars. And some shooters, like those in Brazil, compared their success with that of other shooters who did not use the bullet, on several hundred patients. Some shooters also try slightly different bullet. They try azithromycin, hydroxychloroquine/azithromycin/zinc, azithromycin/zinc, or hydroxychloroquine/doxycycline, and they say these slightly different bullets work too. They have fought many battles with these bullets and accumulate experience, share their knowledge. They are so confident about their bullets that now they are even filing petitions or envisioning lawsuits against their Generals, which on their side threated to suspend the shooters if they continue to use these bullets, at least in France. Sure, anybody has the right to be skeptical about what is going on. But one should not forget that these shooters do not work alone and share their experience. In Marseille, they are supported by a team of 600. Were all these people complicit of a cheat? Would they stand behind their Chief shooter if he only had produced “fake news”? Sounds a little bit too much like a conspiracy theory to me! And what about these other shooters who increasingly use similar bullets everywhere in the world?

>>  Interview with Dr Altino de Almeida – Part 3

Randomized trials?

But let’s accept that in spite of all these evidences, it is worthwhile to produce more definitive proofs. The most effective way to provide such definitive proofs that these bullets do not work if that’s the case is to test them in what we call “randomized trials”. In these tests, you have to use the bullets and count the score, but you also have to shoot blank bullets, called control or placebo, to be sure that you don’t get your results just by chance, and you can use other types of bullets to make a comparison and find out which one is the best. It would be easy to organize such tests since these bullets are easy to produce. They are in production since decades in many factories in the world and many could be produced, for the shooters to improve defense, and for Generals to organize many tests. Sure, we all want these tests to take place, to get the best possible ammunitions and the highest confidence in them. Meanwhile, we trust the bullets that the shooters are using. We don’t want them to be taken away by Generals without proof that the shooters are cheaters, especially given there are no other bullets available. But that does not mean we don’t want more definitive proofs to be produced.

The strangest thing is that Generals, on the other hand, behave like if they did not want these proofs! Only one test was organized early enough to have its results already available. It was a small one, and it did not even test the bullet that for now is considered the best. It tested hydroxychloroquine, not hydroxychloroquine/azithromycin. In that test, they actually found out that the hydroxychloroquine bullet was effective, compared to blank bullets, which is already an interesting result, since the hydroxychloroquine/azithromycin bullet is supposed to be even better. But the Generals did not trust the results. The test was done in China so maybe they think the Chinese screw the results. OK, why not! But then, the Generals should organize their own tests, right? Well, they organized a few tests but did not test the hydroxychloroquine/azithromycin bullet either in these tests, or they tested it on patients that are severe or close to turning zombie. It is the case even in France, where this bullet was designed, where Generals say it should not be used, and where all this created a political mess. The HYCOVID trial repeats the Chinese trial with hydroxychloroquine alone, while the COVIDOC trial has no control, that is, it does not make the comparison with blank bullets. The French also designed the Discovery international trial and it has the same problem. It tests the hydroxychloroquine bullet, not hydroxychloroquine/azithromycin. Same thing with the RECOVERY trial launched in the UK, whose preliminary results were recently published but don’t answer the question we are interested in since it test hydroxychloroquine alone; just like the international Solidarity trial and the ORCHID American trial. There are also tests on the prophylactic use on hydroxychloroquine, whose results show positive effect or no effect, but whose method are sometimes disputable and do not test the most promising bullet either anyway. One test, recently launched by American Generals, makes a noticeable exception in that it tests the hydroxychloroquine/azithromycin bullet to protect patients before their attackers become very virulent, before the patients are sent to hospital . We hope this test will provide strong evidences about the bullet but it comes a little bit late. The battle may be over when the results will be available.

Meanwhile, shooters continue to use hydroxychloroquine/azithromycin and to produce reports that. Adding to each other, can increasingly be considered as proofs. The most recent battle shows that the bullet can in fact even kill quite severe attackers on patients already in hospital, a result that is even beyond what was initially hoped. Problem is this is done by counting the deaths after the battle. It is not a randomized trial. They did not compare with blank bullets. They just compared with what happened on patients who did not want or could not be defended with these bullets for various reasons. 14.8% died and 23% went to intensive care unit, while for those protected with the hydroxychloroquine/azithromycin bullet, only 2.2% of died and 6.7% went to intensive care unit. This is quite an impressive result but it is not a definitive proof that the bullet works, because chance could partly explain the results. The problem is that now, with the cumulated experience of so many shooters, the evidences that the hydroxychloroquine/azithromycin bullet works have become very strong, even if not definitive. It is thus difficult to find people who accept to be defended by blank bullets! Clearly, I would not accept that myself. Would you? So, it looks like rigorous randomized tests will never be implemented and that Generals will continue to say that the bullet does not work while it will continue to save people on the battle ground.

Generals, indeed, start to count death on battlefields too. They use the same method they don’t trust to reach their own conclusion. But they don’t count the thing that needs to be counted to advance in that debate. They use the hydroxychloroquine bullet mostly to shoot zombies, or strong attackers that already caused patients to be in hospital, whereas this bullet is not effective at shooting zombies and should be used as soon as attackers are there, to avoid hospitalization. Generals counted deaths in hospitals in the USA, in New York State, in New York City, and in Manaus in Brazil, and even globally, to see if people protected with the hydroxychloroquine/azithromycin or hydroxychloroquine bullet die less, whereas those who designed the bullet said it’s good to kill attackers BEFORE they become strong and cause people to be sent to hospitals! I know, I repeat myself, but this has been said so many times by so many people and it’s like nobody wants to hear it! All this is just becoming insane!

There is another problem, and quite a big one! Generals are not on the battleground, contrary to the shooters who use the hydroxychloroquine/azithromycin bullet themselves. Thus they rely on data they receive from the battleground and many issues show that these data are not reliable. They may even have counted Australian death who don’t exist! Eventually, the advisers who helped the Generals to count the deaths have decided to withdraw their report! 

But let’s suppose a moment that the data received from the battle ground are correct. Even in that case, we find enough problems in these reports to show that counting death staying on a desk far away from the battleground produces unreliable conclusion. Let’s look to the last study, the global one. The authors say they apply the treatment 48 hours after diagnosis, but don’t say how many days passed between first symptoms and diagnosis. So we do not know how many patients are at the early stage of the diseases in their sample. Probably few since they are all hospital patients and generally people don’t go to hospital as soon as they have the first symptoms. In fact, the authors state themselves that their data on the effect of drug therapy on survival “do not apply to the use of any treatment regimen used in the ambulatory, out-of-hospital setting”. This means their results, even if they were based on reliable data, could not contradict those obtained by IHU Méditerranée Infection or other teams who used the IHU protocol, since this protocol is designed for and used mainly on ambulatory, non-severe patients to reduce rate of aggravation and hospitalisation (to shoot attackers before they become strong). But in the last line of the article, the same authors conclude that “these drug regimens should not be used outside of clinical trials.” Generals who only read the last lines of the article can then use these results to justify rejection of using that bullet in any circumstance, even on ambulatory patients. Il is like if we had to stay without bullets on the battleground because these bullets cannot save people who have already been shot and injured! Journalists also fall into that same trap of confusing the beginning and the end of the battle, that is, two different therapeutic circumstances. Moreover, during the 48 hours between the diagnosis and the treatment, and during the period in between the collection of baseline data and the treatment (how long is this period? The authors don’t say), the state of the patients could have improved or worsened. It would thus have been necessary to introduce a variable “change in the state of patients in between diagnosis or baseline and treatment”, et control the effect of this variable. Otherwise, the study could have an unaccounted selection bias: the patients who aggravated could have received the treatment more frequently, according to a logic of compassionate use. Thus, certain patients would have received the treatment because they died, not the other way around. The study would then prove just nothing. In other words, it may be that there were more zombies in one group of attackers and that this was the reason the bullet was used against this group, whereas this bullet does not work against zombies, and this bias may not have been accounted for in the analysis because the baseline data would have been collected before these attackers turned zombies. But I leave it to advanced statisticians, which I am not, to examine that problem more closely.

>>  Dr Zelenko Interview – Part 2

Meanwhile the shooters continue to use the bullet, since they see that it works and that it’s not just luck! Having done no test to definitively prove or disprove the effectiveness of the hydroxychloroquine/azithromycin bullet, Generals then try another strategy to discredit it. They say it is unsafe, statements that are made at least in France and the US, even though the two compounds in that bullet have been used million times in million patients since decades and they have no record of significant negative side effect. True, a study shows that although hydroxychloroquine has no serious side effects, the treatment  that combines it with azithromycin does. But medical doctors who use the drugs in France, in Marseille and Paris, know these side effects. They handled them by proper monitoring and by not giving the treatments when contraindicated. They observed no severe consequences of side effects even when using the hydroxychloroquine/azithromycin treatment on thousand patients. But still, the discredit campaigns continue, just showing the bad faith or incompetence of Generals who don’t like this bullet and still don’t even try to test it.

Using “Science” against knowledge

That’s a really weird story. I still cannot figure out why Generals do not organize the kind of tests they want, even though they have very smart advisors who know how to design the best possible tests instead of counting deaths on battlefields. Well, there is a possible explanation. I don’t dare to think about that because it’s a terrible explanation. It looks like a conspiracy theory, another one! And I don’t want to turn or look like I am turning paranoid. At the same time, it’s the only explanation I can see. The bullet that are being used on the battleground are very cheap. They can be manufactured by other countries and sold super cheap because they are an old drug that is not anymore protected by copyright. On the other hand, the General’s advisors have friends who work in the bullet industry and are developing fancy new bullets that cost a lot of money and will generate high profits thanks to copyright protection. What if these advisors wanted to secure a market for their friends and their fancy bullets? That would be terrible! It would mean they would be ready to leave people die, without bullet to defend themselves, just to secure the profits of their friends? No, I don’t dare to think that way. It’s just too awful. We cannot judge all these smart people who advise Generals. We cannot see them as accomplices of some kind of corporate crime! These advisors are respectable, educated, smart, polite people who appear frequently on TV shows. So no, I don’t want to turn paranoid and see evil everywhere. At the same time, there is another voice in me that says that maybe I am turning a bit naïve if I reject that explanation. That voice is there because I start to notice other things.

One thing is that it would not be the first time that the bullet (drug) industry cheats about the effectiveness of its weapons. The other thing is that the bullet industry is very active in trying to influence Generals, is a partner to organize the tests, and collaborates with many researchers who organize tests, for example in the recent international study that we discussed already. One firm called GILEAD funds them in part, providing the bullets, at least its own bullet called remdesivir. This bullet is expected to be super expensive! GILEAD spent a lot of money to develop it but the bullet did not find a market yet. The stock market value of GILEAD goes up or down every time there is an announcement in the media saying remdesivir would work or not against COVID. But there are no strong evidences that the bullet works. You can’t find even the kind of evidences we have for the hydroxychloroquine/azithromycin bullet. A report says patients treated with remdesivir improve, but there is no comparison with blank bullet. Here too, they don’t do a proper test. The only available study with a blank bullets says remdesivir is not associated with significant clinical improvements. Stock markets and lobbies, rather than evidence and facts, explain why Generals are increasingly promoting the use of remdesivir bullets in the battles. 

These are our thoughts. The problem is that, like we have no definitive proof that hydroxychloroquine/azithromycin is an effective bullet, we have no definitive proof that the industry biases the organization of tests. But what does “definitive proof” mean? Today everybody is obsessed about proof. We can’t say anything, make any statement, without a proof obtained in tests that Generals and their advisers call “randomized experiments” with a “placebo” in a “controlled” environment. True, these tests are a way to be sure, or almost sure (100% sure does not exist in science, but statisticians say we can be 95%, 99%, or even 99.9% sure with these experiments) that we don’t get our results by chance. But the world did not wait for randomized experiments to be able to produce relevant knowledge. Medicine started to exist and be effective before it used randomized experiments. Moreover, randomized experiments make it possible to be sure about the results for the people in the experiment, and in the setting of the experiment, but doubt remains for other people and other settings. The treatment does not always have the same effect outside the experiment, because the people and the context are different, and the same experiment can give different results depending on the context. You can then conduct a lot of experiments until you get one that gets the results you expect, and publish only the results of this one. 

Also, you cannot test many bullets at the same time in such controlled experiments. All bullets have to be exactly alike and used the same way, or you can only compare a few types, whereas in real life, like on the battle ground, shooters try their own adaptation, are confronted to a variety of situations, and can learn about which conditions make the bullet more effective, depending on the kind of attacker and the kind of people to defend. Eventually, not everything requires a randomized experiment. You don’t need an experiment to show that a parachute can save a life. And you don’t need one to show that a molecule can kill a virus. It is good to use the randomized experiment to reduce the level of doubt, but when you see repeatedly that the virus dies every time you shoot, you eventually reach a point where it would be insane to tell your patient: “sorry I won’t shoot that bullet to kill that virus because you are in the control group”. Or: “I will shoot a bullet but maybe it’s a blank bullet that will make nothing, and I can’t tell you; I will just flip a coin”!

So, let’s have a bit of judgment and common sense here. It’s time to ask for a reversal of what has to be proved. Shooters use the hydroxychloroquine/azithromycin bullet every day, say it works, and they cannot be all liars. So, we have to trust them, and prove they are wrong if that’s what we think. Otherwise, science will become an instrument used by people who want to produce the kind of proofs they want, instead of being used to produce objective knowledge. This point has to be taken seriously since the industry has no interest in testing a bullet that’s cheap and can compete with its fancy, expensive weapons. Generals need to acknowledge that controlled randomized experiments are not the only way to produce knowledge, and can be biased precisely because they are controlled by the few who can fund them and provide the fanciest statisticians. It is very easy to do many experiments with different controlled settings and then to publish only those giving positive results. Who is “controlling” these experiments right now? That’s not something we investigated yet but clearly, pharmaceutical labs are on the stage. General need to take control of experiments and request that the hydroxychloroquine/azithromycin bullet is tested too, and not to shoot zombies! One General made that step in America, as we said. Let’s hope others will follow.

>>  Dr Zelenko Interview - Part 1

There is another weird thing that is happening in that story. You would expect many people to comment on hydroxychloroquine/azithromycin controversy, especially journalists in newspaper. Well, they don’t really. They comment around that, but not exactly upon that. They comment on the shooters, not the bullets. They say the shooters are bad at other things than shooting. In fact, they say they don’t like the shooters who use that hydroxychloroquine/azithromycin bullet. They don’t provide any definitive proof that the bullet does not work, which is normal, since no randomised test has been designed to check that. But they say nevertheless, or at least they imply, that the bullet should not be used. They say we don’t know if it works, that it is and “unproven treatment”, a “questionable cure”. 

They do that for two reasons, in addition to the fact that they don’t like certain persons. First, they are not scientists and do more politics than science. They use scientific results preferably in a way that is consistent with their political agenda. Second, like the Generals and many other people, they don’t understand what science exactly is. Surely, they are correct when they say hydroxychloroquine/azithromycin is an “unproven treatment”,  if by “proven” they mean 99% or 99.9% sure. But imagine you make decision in your life only when you are 99% sure it’s the right decision. Certainly, you would be paralysed most of the time, and the same would apply to any decision maker or government. 99% certainty, supposing it is possible, does not come straight. There are always trials and errors to go through first, through action, and very often you don’t even reach 95% certainty. When we don’t have time and have to act in emergency, certainly we make more errors. But can that be worse than doing nothing when the disaster is there and wipes out thousands of people every day? No, it’s not. The generals, their advisors and many journalists have confused two notions: that of knowing something with absolute certainty, and that of knowing in the more casual sense, which means, being confident enough in a belief to act like if that belief was true. They forgot that this second way of thinking also applies in science. A scientific theory is accepted not necessarily when it is proven, but when it explains the observed fact better than any alternative theories. At the moment, the theory “hydroxychloroquine/azithromycin heals non severe COVID patients” is more consistent with observation than the alternative theory “hydroxychloroquine/azithromycin does not heal these patients,” as we can be convinced by this recent publication. To say “we don’t know” is not a theory and is useless or dangerous since it leads to not taking a chance of doing something using the knowledge already available. This statement could be accepted only if we were totally ignorant, but we are not. Thus, it just reflects a poor understanding of what science is and turns available knowledge into ignorance.

Conclusion

No experiment has thus been launched to test the effectiveness of using the hydroxychloroquine/azithromycin treatment, even though these molecules are considered among the most effectives by most medical doctors involved in the battle to treat COVID-19 patients at the beginning of the disease, except for one study recently launched but whose results may be available only when the battle will be over. Like said French President Emmanuel Macron, we are “at war” against COVID-19. But it looks like the war is in the media as much as in the patients’ body, and that it mobilizes businesses against medical doctors deeply concerned by the way governments manage the crisis. The latter have collectively developed a cure and several variations on this treatment, but they are opposed by probable scientific fraud, or with arguments that look more like deliberate attempt to discredit the treatment without looking at the facts, looking at them in a biased way, or using a number of tricks that have been very nicely described here. Debates are about people who promote the treatment, like Professor Didier Raoult in France and President Trump in the USA, instead of being about the therapeutic approach itself, which remains untested under rigorous randomized experiments, in spite of the high stakes. Meanwhile, patients continue to aggravate and die without being given the full range of options that have a chance to cure them. In the end, discredit will fall on scientists, journalists, and decision makers alike. Distrust for elites will continue to rise, except for Trump who, in spite of his habit of lying and being ignorant, listens what the shooters say and reports on their success, unfortunately also adding his own fantasies on how to treat COVID. Viewpoints biased by populism on one side, by business and vested interests on the other side, will continue to rise, the latter having even worst outcomes than the former. In the middle, there will be little space for the evidence-based knowledge that everybody is calling for.

Does all this sound like conspiracy theories? Well, it sounds like, but it’s not. Cognitive dissonance is a more relevant concept to understand what happens. Both parties believe in what they say and think. They believe in it because it is the way of thinking of the group to which they belong. To be against your group, to live in a view of reality that is at odd with that of your own group is painful and that’s why most people can’t do it. I know because I experienced that myself. To realize that decision makers have made the wrong decisions to that extent and that the consequence of these decisions is more deaths that could have been easily avoided is just propelling me outside my comfort zone. I believed in the skills and commitment of committees of experts and journalists, at least in a domain where you cannot escape from being confronted to facts (that’s what I thought) like healthcare. I believed these experts would be well prepared to make the right decisions based on straight facts. But I observed they were not. This observation is painful. It would be easier to believe the mainstream view spread by the media, watch the TV news every evening, and manage my life according to a plan set by my government. But with the internet, TV news and mainstream newspapers are not the only way to access information. I can now access the facts more directly and assess if experts and journalists do their job properly. Doing that I observe that there are two kinds of opinions on COVID treatments. That of people who access firsthand information (medical reports and scientific articles), who believe in the efficacy of hydroxychloroquine/azithromycin at early stage of the diseases, and that of people who access second-hand information only (journalist articles and TV news), who reject and even blame this treatment. Like many others who report their findings here and there, I can look at raw data from reports and scientific publications like those cited in this article. We cannot see the facts directly. We cannot see the lab records showing viruses dying in the body of patients. But we can choose to read the writing of those (scientists) who see these records, rather than articles of those (journalists) who talk with those (experts) who read the writing of those (scientists) who see these records! Instead of listening experts and journalists, we can listen direct testimonies, and read reports and scientific articles showing that when people are sent home with paracetamol, many aggravate and then go to hospital where a high proportion die, and that when given azithromycin or possibly another antibiotic, with hydroxychloroquine, the risk of aggravation and death is much lower. We can read that a drug, hydroxychloroquine, has been used since decades by million patients without significant side effects, and that it is now described as some kind of poison. We can read about the ostracization of medical doctors who prescribe these drugs, and the flurry of praise given to a treatment, GILEAD’s remdesivir, that has no evidence of effectiveness. And we can read about GILEAD lobbying efforts and GILEAD’s stock value rise when its lobby is successful. The feeling once we take these shortcuts to more grounded knowledge is like being unplugged from The Matrix. It is a painful sensation! We can’t watch and trust TV news anymore after that. We don’t belong anymore to the world we are supposed to belong. We turn to a state of cognitive dissonance with most people around us, including loved ones. But that’s the condition for a diversity of views and the truth to arise. These visions will collide and there is probably a regenerating power in that, a remedy to social entropy and the gradual deterioration of our values and beliefs by the power of finance and industries. Will a righteous future emerge? Let’s hope at least that the facts will straighten out the debate in the end and that we will use that lesson to address other societal challenges. 


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