President Trump stirred up a controversy first by touting the use of hydroxychloroquine to treat Covid-19, and then by musing about the use of UV light and even disinfectant to cure the disease. The way some have defended Trump’s speculation has served to spotlight a dangerous strain of partisan loyalty at work among many of his supporters.
But this tribalism that insulates itself from evidence is a contagion from which neither side of our political culture is immune. It infects not only the debate about how doctors should cure Covid-19, but also how governments should seek to contain it.
The thinking behind a partisan medical controversy
The controversy about disinfectant laid bare how some of the President’s supporters have been driven by blind loyalty, not a concern for evidence and truth.
On social media, I saw Trump’s defenders ignore the most worrying of the President’s claims, the idea that we should look into injecting disinfectant into the human body. Instead they drew attention to studies about the use of UV light that were not demonstrably related to the President’s comments. They were then eager to embrace the President’s claim that he was being sarcastic about disinfectant — a claim that is hard to square with his demeanor toward Dr. Birx at the press conference.1
The promotion of hydroxychloroquine followed the same pattern: partisan cheerleading, not evidence, is what empowered the trend. Supporters of the drug did cite anecdotal evidence of patients who had recovered after taking the drug.2 But because most people with Covid-19 recover anyway, these reports did not present serious evidence of causation. Only careful randomized control trials using large and representative samples give that evidence, and none of these had been done when social media first lit up about the drug.3 What had occurred was a media campaign by Fox News, which was then taken up by the President.4
Consider how hydroxychloroquine boosters characterize their opponents and critics. For instance, the boosters spread a rumor that state governors had issued an outright ban on the drug. This isn’t true: these states prohibited outpatient prescriptions to preserve supplies of a drug that provably treats lupus, but they allowed inpatient prescriptions for those being treated for Covid-19. 5 Likewise, when I’ve pointed out the scant evidence for the effectiveness of the drug, its supporters baselessly pigeonholed my views. They said that I must think that no one should ever try the drug or be allowed to try it. But that’s not my view. I think people should have the right to try potentially life-saving drugs even when there are risks.
Both of these reactions involve a kind of false-choice thinking. One can think that doctors should be able to prescribe the drug, but also think prescriptions should not be given out indiscriminately. One can think that people should be free to try a drug but also think they should decide based on the evidence. One doesn’t have to choose between being an unqualified advocate of the drug and a categorical opponent. But partisans for these drugs argue as if there are only two choices.
But, it’s a mistake to think that only Trump supporters can be diagnosed with this unhealthy way of thinking.
The same thinking at work in the lockdown debate
As there is a legitimate scientific debate about how doctors should treat coronavirus, so there is a legitimate debate about government’s role in containing it. It is fairly obvious that government can justifiably quarantine individuals with a threatening infectious disease. But statewide mandatory shelter-in-place orders are legally unprecedented. To justify them would require shouldering a heavy burden of proof. So we should expect and welcome criticisms of these orders.
Yet I’ve now seen advocates of statewide mandatory lockdowns accuse their critics of not caring if people die and of thinking that all social distancing should be abandoned. That’s another false choice. One can be concerned about both the destruction of livelihood resulting from the lockdowns and about the sickness and death wrought by the coronavirus. One can oppose widescale mandatory lockdowns and still think people should voluntarily engage in social distancing to the extent they can.
Advocates of the lockdowns who engage in such false-choice arguments should think seriously about why they exhibit the same defensiveness that the hydroxychloroquine boosters do. Do they support the lockdowns because of careful consideration of the evidence? Have they looked at scientific studies that demonstrate the superiority of widescale lockdown measures over campaigns for voluntary social distancing?
It’s hard to believe attention to the evidence could be what is driving support for the lockdowns. I can’t find studies of lockdown effectiveness that have been widely publicized. Studies of the effectiveness of school cancellations, travel restrictions, assembly limits, and centralized quarantines are not studies of wide-scale lockdowns.6 Like the studies of hydroxychloroquine, the few studies of actual lockdowns that do exist are also not randomized control trials.7
Supporters of medical or political interventions both point to scant evidence of their effectiveness but argue that we don’t have time to wait for more. They should admit that their proposals are not based on adequate evidence; they are gambles. A gamble might even be rational if it doesn’t dismiss evidence of the dangerous side effects of the proposed intervention. But many on both sides have ignored evidence of these side effects.8
Could it be that many of those who support draconian mandatory lockdowns have also been motivated not by careful consideration of the evidence, but by fear of the disease and hatred of the politicians who oppose them?
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If we want to salvage as much as possible of both our health and our wealth, we need creative solutions that see beyond the false choices we’ve been offered. To find these, we cannot be guided by fear or tribal hatred. We need level-headed, rational thinking aimed at figuring out what’s true, what’s effective, and what’s just — whether or not it fits a partisan agenda.
- “Trump floats dangerous coronavirus treatment ideas as Dr Birx looks on,” Guardian News YouTube channel, April 24, 2020.
- This is not to say that the anecdotal evidence is sparse. There have been several published studies showing the recovery of a significant number of patients who have taken the drug. However, most of these studies did not involve randomized clinical controls. For a good overview, see Derek Lowe, “Hydroxychloroquine Update For April 6,” Science Translational Medicine, April 6, 2020.
- One controlled study showing positive effects used only a very small sample size and a population unlikely to be affected by the side effects of the drug. See Zhaowei Chen et al., “Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial,” MedRxiv: The Preprint Server for Health Sciences, April 10, 2020. For a critique of the study, see this Twitter thread from Luciana Borio, former National Security Council Director for Medical and Biodefense Preparedness and former FDA Acting Chief Scientist. Another recent study by the VA with a larger sample size showed no positive effect from the drug. See Joseph Magagnoli et al., “Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19,” MedRxiv: The Preprint Server for Health Sciences, April 21, 2020.
- Beginning in the middle of March, Fox News began mounting what looked a lot like a campaign for the merits of the drug. According to Media Matters, between March 23 and April 6, Fox featured voices promoting the drug nearly three hundred times, while critical voices appeared only about thirty times. (See Lis Power and Rob Savillo, “Fox News has promoted hydroxychloroquine nearly 300 times in a two-week period,” MediaMatters.org, April 7, 2020.) President Trump joined the bandwagon and started touting the drug, calling it a “game changer” and recommending that people try it. (See Matt Gertz, “How Fox News convinced Trump that it found a miracle cure for coronavirus,” MediaMatters.org, April 6, 2020.) Soon after Trump’s promotion, social media lit up about it. (See Elyse Samuels and Meg Kelly, “How false hope spread about hydroxychloroquine to treat covid-19 — and the consequences that followed,” Washington Post, April 13, 2020.)
- Daniel Funke, “Chloroquine is not banned in Michigan, New York and Nevada,” Politifact.com, April 2, 2020.
- Lyman Stone, “Lockdowns Don’t Work,” Public Discourse: The Journal of the Witherspoon Institute, April 21, 2020. Notably Stone observes that most of these statistical studies of actual lockdowns also don’t work when timing is taken into account: the countries that imposed lockdowns experienced decreases in mortality before the lockdowns could have made a difference, given what we know about the incubation period of the disease and the time to mortality.
- Such trials are usually impossible to conduct on government policies: you can’t control for all the variables that affect the outcome of real-world policies as you would in a lab. Stone notes a study of real lockdowns in West Africa against Ebola. At the same time as the lockdowns were imposed, education and medical supply campaigns were also launched, and it is difficult to control for the effect of these other variables. One proponent of lockdowns acknowledges that of course there is no randomized control trial evidence for lockdowns, but argues that there is no time to wait for that data: we have to rely on statistical correlations and historical analogies instead. (Richard Holden, “Evidence of lockdown effectiveness is there if critics care to look,” InDaily (Adelaide, Australia), May 1, 2020.) Of course the more sophisticated proponents of hydroxychloroquine also pointed to studies showing that a large percentage of people given the drug recovered, and argued that when a patient is dying, there is no time to do proper controlled studies.
- For more on how proponents of lockdowns twist the economic evidence to downplay the economic effects of the policy, see my article “Arguments for Lockdowns Misrepresent Economic Evidence,” New Ideal, April 17, 2020.