When the U.S. History courses one hundred years from now reach the Covid-19 lecture, there will be one of those “humorous yet informative” postscripts that professors enjoy, at the end of the holographic PowerPoint slides being beamed into their students’ cerebral cortexes by the benevolent Planetary AI (or carved onto whittleboard, the few remaining pupils hunched over to see by candlelight as the Planetary AI’s hunter-killer mechs shake the earth 100 feet above, whichever). And that postscript will involve hydroxychloroquine.
The anti-malaria drug was one of many existing medicines hypothesized early on to have some action against the coronavirus or its related complications, along with zithromax, remesivir, and tocilizumab. But there has yet to be time to evaluate any of these — even a full retrospective study for any of these will takes months to finalize, and true double-blinds only really got started within the last month or so, and will take even longer. So all we clinical physicians have had to go by are our best guesses.
But why should any of this be of interest to any future undergrad student, or anyone besides the most thorough postgrad researcher of this era? Because hydroxychloroquine has become a major political issue, and, as usual, all due to a random idea that had flitted through our president’s brain. On March 19, over two months before I’m here saying it’s still way too early to know what existing medicine, if any, are effective against the virus, Trump pronounced his endorsement of hydroxychloroquine as an effective drug in during a daily briefing.
The effect was both massive and instantaneous. Prescriptions surged as people demanded the medicine from their primary care doctor, and the unproven med, with potential side effects, was already part of the standard Covid-19 protocol at a NYC public hospital by the time I started seeing inpatients on April 15.
Within two weeks, however, I and most other providers refused to continue supporting this possibly harmful drug, as it has having little impact on the hospital’s death or extubation rates and, more importantly, broader literature was suggesting evidence against the med — although, again, with the cautionary note that absolutely nothing is settled science yet. (update 6/3/20: And how. The study suggesting harm caused by this medicine was itself flawed.)
It’s just that we frontline clinicians don’t have the luxury of time. We have to go with whatever hypothetical might work. By the end of April, that meant ditching the Plaquenil and trying to get our hands of the hospital’s limited supply of tocilizumab and, later, remesivir. Why? Was it because the hospital was anti-Trump? Would we treat medical decisions based on party affiliation? If that were the case, we never would have tried the Plaquenil at all to begin with. We’re just trying to use the evidence of our eyes and ears, rather than going with what we want to be true.
Because that right there — going with what a person wants to be true — has almost entirely defined human existence since antiquity. It is the source of irrationality, of witch hunts, of wars of extermination. People going with what they know in their heart to be true led to the horrors of communism, of Nazism, of Islamic extremism, as well as latter-day evils such as anti-vaxxism, Scientology, and QAnon.
After the medical community turned its back on hydroxychloroquine, the president did what everyone does when their irrational beliefs, held because of what their gut tells them, are challenged: he doubled down.
And as this is medication is now a political issue, that it is a panacea has become an article of faith among the Trump fanatics as much as their belief that masks are harmful, reported Covid-19 death rates are fake news and proposed vaccines are nothing but a vast conspiracy fomented by Bill Gates, Big Pharma, the Deep State, Dr. Fauci, and whichever other insidious “THEM” that the latest YouTube ranter decides to throw in for good measure.
As part of trying to deal with their new reality after editor Rich Lowry’s total surrender to the Bircherism that his magazine was founded to oppose, National Review sometimes puts up posts asking the MAGA zealots to, y’know, take it easy. “The bottom line is that we need large, randomized trials with proper control groups to know what difference this drug makes,” Robert Verbruggen concludes in a blog post today, which would be about as controversial as “water is wet” to most. But not to the cultists in the comments section:
“…The general consensus is that HCL is most effectively used as a prophylactic, to be taken before infection by the corona virus occurs, similarly to how it is used to prevent malaria…. HCL is seen to be only slightly effective as a therapeutic treatment for active COVID cases. Of course, the therapeutic use is all the mainstream press focuses on because it is the least understood, and can thus be easily twisted to criticize and mock President Trump, which is all that is important to them.”
Everything is about defending and worshiping former host of Celebrity Apprentice to these people. Everything. So naturally, they assume everyone else is the same.
But magical thinking — going with what you want to be true, rather than what the evidence shows — is not a craziness confined to a few crazy relatives on your Facebook feed. It is the default. It is the natural way of thinking for humans.
Because we can convince ourselves that anything we want is true. ANYTHING.
The QAnon crowd is an extreme example, but they convinced themselves that the following is true, based on the ravings of a 8Anon troll: that military tribunals are happening or will happen for prominent Democrats, media figures, and others that they and Donald Trump despise; that these will lead to executions, which delights them to no end; that some liberals have *already* been executed and what we see are the body doubles of Obama, Hillary, etc.; that any day now, Trump will install a full military dictatorship (this is the “coming storm” they talk about) leading to any remaining liberals, dissidents, or journalists being rounded up in concentration camps and/or murdered outright; that major news stories such as Covid-19 are all actually part of the vast secret conspiracy against Trump; that JFK Jr. is actually alive and on their side (don’t ask me to explain because I can’t). And that’s just the surface!
If this all sounds like a self-published horror story by some meth-head cranking out words at 3am, well, that’s only partly accurate. Because all of this — the murders, the dictatorship — isn’t what they fear but what they fervently want more than anything else in this life. They *want* Obama to be lined up against a wall and shot. Therefore, for their reality, that is precisely what’s going to happen.
And a lot of these types also believe in various, unrelated, sometimes self-contradictory other conspiracy theories, including the all-time classics. Flat earth. Anti-vaxx. The Rothschilds and other anti-Semitic tropes. And, of course, that hydroxychloroquine is a miracle cure because the president says so. Hey, reality is whatever they want it to be, after all. Why not season it to taste?
The Enlightenment and its ideals stood against this magical thinking that has defined human existence since the first proto-human decided that thunder was caused by their god throwing rocks at the sky and that any who diagreed needed to have their head bashed in. And as humanity turns its back on the Enlightenment, the curse of magical thinking and anti-intellectualism settles back over the human landscape like a weighted blanket.