In that study, which is ongoing, Covid-19 patients are treated with a combination of hydroxychloroquine and an antibiotic, azithromycin. Photograph: Gérard Julien/AFP via Getty Images “This is insane!” one scientist tweeted recently, about the Marseille study. That’s why now, as in 1918, you see scientists castigating each other in the media. She makes ethical choices of her own, in other words. The best they can offer is a range of possible outcomes with probabilities attached, and sometimes that range is so broad it’s next to useless for a policymaker – so the scientist is forced to step out of her comfort zone and narrow that range based on criteria other than evidence.
But we don’t live in an ideal world, and that division of labour is an illusion.Īs the philosopher David Kinney of the Santa Fe Institute pointed out this week, scientists rarely have all the facts in a crisis. The politicians would shoulder the ethical burden. In an ideal world, the scientists would furnish the facts and the politicians would weigh them against other facts and make decisions. But the deeper truth revealed by these examples is that in a crisis, it’s not only politicians who are forced to make ethically loaded decisions doctors and scientists are, too.
In his book about the British experience of the 1918 flu, Living with Enza, Mark Honigsbaum reports that Londoners refused to be fobbed off with advice to gargle with saltwater, and besieged chemists and doctors’ surgeries demanding quinine. At that time there was less understanding of how a drug interacted with the body, and they often over-prescribed it, causing side effects such as vertigo, tinnitus and vomiting.
In 1918, in the midst of the worst flu pandemic in history, doctors all over the world prescribed quinine, another anti-malarial drug, even though there was no evidence that it worked for flu. Larger trials of this and other treatments are under way, but won’t report even preliminary findings for another week. The run on hydroxychloroquine is the result of a small trial being conducted at a hospital in Marseille that, though promising, has not yet provided the required standard of proof that the medicine works for Covid-19 – let alone information about when it works, or in what doses.
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