The deathless persistence of the hydroxychloroquine story illustrates how hard it can be to let go of cherished beliefs.
In a news cycle where 2-3 days feels like 7 and last week’s news already feels a month old, one of the longest-running sagas has been the status of the drug hydroxychloroquine as a possible treatment for COVID-19. It is the zombie story that will not die.
First hydroxychloroquine was a cure (according to Didier Raoult at Aix-Marseille University), then it wasn’t (the now-retracted Lancet study using Surgisphere’s dodgy data), then it might be (the resumption of World Health Organisation clinical trials), then it definitely wasn’t (based on the results of the RECOVERY trial).
Raoult is still hyping it, but the scientific consensus on its efficacy is now firmly against usage. (See here for a previous posting on the messy business of scientific consensus building in the context of the coronavirus pandemic).
Raoult, however, is not alone. Last week an organisation called America’s Frontline Doctors – their principal spokesperson a clinician-pastor who has also cautioned against the dangers of demon semen – spoke glowingly of the benefits of the drug, and against the use of masks.
By itself this incident wouldn’t be too noteworthy. Fringe groups with ulterior motives can always be relied upon to push their own views (especially during a crisis), and the internet is perpetually awash with such ideas and other conspiracies.
The problem with hydroxychloroquine though is that, like so much of the pandemic response in the US, attitudes towards it have become politicised. The video of America’s Frontline Doctors was retweeted by Trumps Senior and Junior, and both have been steadfast – in the face of the scientific consensus on the issue – in their advocacy of the drug. Trump Senior even claims to have been using it as a prophylactic (against the virus). Given the extensive online audiences that both men have, this constitutes a significant circulation of misinformation.
But why do it? When a scientific consensus has been reached, why do people such as Trump, and particularly Raoult, go on insisting that they’re right and everybody else is wrong?
As every scientist knows, recanting one’s own prior beliefs and conclusions is possibly the hardest trial to undergo, given the effort that’s usually expended to obtain those same beliefs. A scientist’s reputation is built to a very large part on their research findings – often hard won, and sometimes established in the face of public opposition. It is not easy to let go.
Publicly admitting that our own cherished beliefs, built on the foundations of our own experimental work, are no longer tenable – an admission that invariably has to be made as a result of a community-wide consensus against us – can easily make the boldest question their own credibility.
This is presumably why many people – not just Trump and Raoult, but many scientists and in many less controversial contexts – hang on to concepts long after they have been rejected by the scientific mainstream. Thomas Kuhn noted in The Structure of Scientific Revolutions that ideas really only go away when their proponents die, and with good reason – people tend not to let go of their dearest beliefs, especially ones that they have personally endorsed to an absolute degree.
This behaviour in itself isn’t unusual. We talk of nailing our colours to the flag and going down with the ship. Shakespeare’s Macbeth acknowledges his own refusal to change course (“I am in blood stepped so far that, should I wade no more, returning were as tedious as go o’er”), committing instead to seeing things out to a bitter and inevitably retributive end. The problem is that we tend to prize such steadfastness in combat and sport, but the same behaviour is a liability in science and medicine.
Despite that, it’s a rare scientist indeed that can be so selfless, and perhaps especially hard in our present culture to practise such self-abnegation. Raoult, exemplifying the scientific alpha male, and Trump (and Bolsonaro), exemplifying alpha males more generally, are probably psychologically unequipped for such levels of introspection and doubt. Their instinct when challenged is to take the criticism personally and go on the attack, rather than ask themselves whether the criticism has any value.
Good scientists, however, know that we mustn’t get too precious with our findings. Almost all we discover will ultimately get overturned or at least updated, if only in terms of accuracy and resolution.
Sometimes scientists do end up revising their own prior positions. A shining example is that of the German physiologist Karl von Frisch, a pioneer in the study of insect communication. Frisch’s career climax of decoding the honeybee waggle dance meant acknowledging the role of the sun and thereby a rejection of his own earlier work which had posited that the dances communicated information on the type of food, not its distance from the hive. Being able to repudiate, painfully, his own previous claims enabled him to gain better and more profound understanding of the same process.
Call it hypothesis euthanasia. If an idea has to go, is it perhaps better you do it yourself instead of playing Macbeth?
Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease in the USA, and a very public face of the American scientific community’s response has – like any good scientist – shifted his position on various pandemic-related issues as the weight of evidence has accumulated. With sufficient data now available, he advocates for facemasks and against hydroxychloroquine.
For this, the White House has repeatedly tried to smear him as being unreliable, but this is good scientific behaviour. You cannot hold on to an opinion that the weight of evidence shows to be wrong just because you previously endorsed it. If you can’t recant, you’ll count the cost.