I hadn’t planned on writing about the overblown promotion of antimalarial drugs like chloroquine and hydrochloroquine to treat COVID-19 so soon. After all, there’s very little in the way of new science. The state of our knowledge about whether hydroxychloroquine might be a useful treatment for COVID-19 is basically unchanged since Friday. Unfortunately, over the weekend, the quackery-promoting right wing noise machine, led by President Trump, went into high gear promoting this unproven drug as a treatment for coronavirus. I also learned more about the sources influencing Trump to do this, primarily Peter Navarro, Rudy Giuliani, and—who else?—America’s quack Dr. Mehmet Oz.
But first, witness a most disturbing scene:
President Trump spent a portion of Sunday’s press briefing yet again promoting an unproven treatment for the novel coronavirus, repeatedly asking, “What do we have to lose?”
So toward the end, a CNN reporter turned to Anthony S. Fauci, the government’s top infectious disease expert, for his opinion on the effectiveness of hydroxychloroquine with a sharper question: “What is the medical evidence?” Standing at the microphone, Fauci opened his mouth — but before he could speak, the answer came out of Trump’s instead.
“Do you know how many times he’s answered that question?” Trump cut in. “Maybe 15.”
A tight smile stretched across Fauci’s face. His eyes, framed by a pair of wire-rimmed glasses, flicked quickly to Trump. He glanced back at the reporter, who was saying to the president, “The question is for the doctor. … He’s your medical expert, correct?”
Fauci’s smile, for just a moment, was all teeth now. Trump raised his finger sternly, telling the journalist, “You don’t have to ask the question,” and so Fauci didn’t answer it, and the news conference shuffled right along.
The video that accompanies the story I’m quoting was literally painful for me to watch. Basically, President Trump jumped in after the reporter asked Dr. Fauci the question and told him not to answer, and he didn’t answer. Meanwhile, during the press conference:
But the president cut Fauci off before he could clarify his viewpoint during today’s conference.
“There are signs that it works on this [coronavirus],” Trump told reporters, citing “strong and powerful signs” it worked. “It’s been around a long time.
“I’m not acting as a doctor, I’m saying ‘do what you want,’ but there some good signs.”
“If it doesn’t work, nothing is lost by doing it,” he added. “I want to save lives – I don’t wanna be in a lab for the next year-and-a-half.
“It can help them but it’s not going to hurt them.”
Wrong, Mr. President:
In a story from Sweden (translated with Google Translate, which did surprisingly well with Swedish):
On March 23, Carl Sydenhag tested positive for the coronavirus after having a fever and breathing difficulties. At Södersjukhuset in Stockholm he received antibiotics intravenously and chloroquine.
“I was prescribed to take two tablets in the morning and two in the evening,” says Carl Sydenhag.
Here’s what happened next:
“I got cramps and a headache that I have never had before. It felt like I had stepped into a high voltage plant.”
Carl Sydenhag says that his vision was also affected and that his peripheral vision was reduced. He then decided to read the package leaflet and saw that the side effects he experienced usually occurred in one in 100 taking the medication.
“Then I called the Poison Information Center that said the dose I had been given was dangerous, so I stopped taking the tablets and went to the hospital again.”
Once at the hospital, doctors thought that Carl probably received an excessive dose of the medication.
Today, he no longer has any symptoms for covid-19, but thinks that his vision is still worse than usual and that he still feels dizzy.
“But I feel much better than I did before. It may have been that the malaria medicine helped against the corona and I am very grateful for that, but you have to dose correctly,” says Carl Sydenhag.
As a result:
Chloroquine has been given to covid-19 in several hospitals in Sweden. But last week, all hospitals in the Västra Götaland region stopped using it.
“There were reports of suspected more serious side effects than we first thought. We cannot rule out serious side effects, especially from the heart, and it is a hard-dosed drug. In addition, we have no strong evidence that chloroquine has an effect at covid-19,” says Magnus Gisslén, professor and chief physician at the infection clinic at Sahlgrenska University Hospital, to the Gothenburg Post.
More detail can be found in this story:
“We might have made another assessment if covid-19 was a disease with very high mortality, for example 80 per cent dead, but now we can manage most people who are intensive care anyway,” says Magnus Gisslén.
He is self-critical that he let himself be drawn into the chloroquine.
“In retrospect, I can regret that we did. We were a bit naive and thought the side effect profile was much better. I have changed my mind and hope that the rest of the country does too.”
Certainly the story above is only anecdotal. We don’t yet have good data on how widespread adverse events from these drugs have been in COVID-19 patients. Nonetheless, it’s plausible. I’ve been warning of this sort of outcome for weeks now, ever since the craze for chloroquine and hydroxychloroquine swept the world and became the latest bright, shiny object to attract the attention of our scientific ignoramus of a President.
After all, it’s long been known that hydroxychloroquine can affect the cornea. Specifically, the drug can cause the formation of deposits on the cornea that begin “as diffuse punctate deposits that, over time, aggregate into curved linear whorls, becoming irregular and branching and involving the pupillary zone.” These deposits are usually reversible with cessation of the drug, but it can take up to a year for them to resolve. Worse, prolonged use can cause a characteristic retinopathy, an effect that is often not reversible. It’s the reason why lupus patients taking the drug must undergo regular ophthalmological examinations. It’s also long been known that these drugs can affect the heart, prolonging the QT interval on EKG and in uncommon cases cause a potentially fatal arrhythmia known as Torsades de Pointes. This risk is exacerbated when these drugs are combined with azithromycin. The law of large numbers means that, even if these serious adverse reactions are very uncommon, if millions of people start taking the drugs, many thousands will be harmed with no good evidence of benefit to outweigh the harm.
We all know that Donald Trump is very impressionable, often basing decisions on advice or information he got from the last person he talked to. So whom is he talking to? Is it any surprise that one of these people is Dr. Mehmet Oz? Of course it’s not:
But Trump has told officials that it would be “a good idea” if they talked to Oz, one of the sources added. Top administration officials, including Trump’s administrator of the Centers for Medicare and Medicaid Services, Seema Verma, have privately spoken to Oz in recent days to discuss the virus and his views on the possible treatment, three sources said. The New York Times first reported that Oz had been in touch with the Trump team.
Oz seemed to confirm his level of access to the administration during an interview with Fox & Friends hosts last week, saying an “astute question” that co-host Brian Kilmeade asked the other day “on this show” actually inspired him to contact Verma about using the Medicare and Medicaid national data to compare coronavirus infection rates in patients already prescribed hydroxychloroquine versus patients who are not taking the drug.
“It’s a rough-and-tumble study, but she’s agreeing to do it, or look into it, anyway,” Oz claimed.
In this case, “rough and tumble” almost certainly means crappy and pointless. In the absence of widespread testing, any such study is likely to be uninformative, particularly given that there are likely to be so many confounders that it will be impossible to control for them all, not the least of which is simple geography. After all, some areas of the country are COVID-19 hotspots right now; others so far have been much less affected.
Of course, it’s no surprise that Trump would have an affinity for Dr. Oz, a.k.a. America’s quack. The two are very much alike: hucksters, showmen, con men. It’s not for nothing that I referred to their relationship as a “huckster bromance.”
Another conspiracy monger who’s been pushing hard to persuade Trump to promote these drugs is Rudy Giuliani, who years ago fully joined the tinfoil hat brigade and has cast himself in a new role, as the President’s personal science advisor (I know, try not to gag):
However, Giuliani said he has spoken directly to Trump “three or four times” about a potential coronavirus treatment, describing to him the results of an initial small-scale study in France that suggested the anti-malarial drug hydroxychloroquine may help treat covid-19. Giuliani said he has not spoken to other White House officials about his views.
He’s also been all over Twitter promoting the drugs, as well as talking them up on his podcast. It got so bad that Twitter even deleted one of his Tweets and temporarily locked his account for spreading coronavirus misinformation by saying that hydroxychloroquine “in at least three international tests was found 100% effective in treating the coronavirus.” Of course, even the most generous interpretation of those three execrable studies doesn’t support that statement. Giuliani is an equal opportunity quackery supporter, though. He’s also been promoting the use of “placenta killer cells” in a stem cell treatment for COVID-19 on social media and on his podcast.
Finally, there was a terrifying article published by Axios over the weekend describing an “epic” battle over chloroquine and hydroxychloroquine:
Toward the end of the meeting, Hahn began a discussion of the malaria drug hydroxychloroquine, which Trump believes could be a “game-changer” against the coronavirus.
Navarro’s comments set off a heated exchange about how the Trump administration and the president ought to talk about the malaria drug, which Fauci and other public health officials stress is unproven to combat COVID-19.
- Hahn gave an update about the drug and what he was seeing in different trials and real-world results.
- Then Navarro got up. He brought over a stack of folders and dropped them on the table. People started passing them around.
- “And the first words out of his mouth are that the studies that he’s seen, I believe they’re mostly overseas, show ‘clear therapeutic efficacy,'” said a source familiar with the conversation. “Those are the exact words out of his mouth.”
Fauci’s mention of anecdotal evidence “just set Peter off,” said one of the sources. Navarro pointed to the pile of folders on the desk, which included printouts of studies on hydroxychloroquine from around the world.
- Fauci pushed back against Navarro, saying that there was only anecdotal evidence that hydroxychloroquine works against the coronavirus.
- Researchers have said studies out of France and China are inadequate because they did not include control groups.
- Fauci and others have said much more data is needed to prove that hydroxychloroquine is effective against the coronavirus.
- As part of his role, Navarro has been trying to source hydroxychloroquine from around the world. He’s also been trying to ensure that there are enough domestic production capabilities inside the U.S.
- Navarro said to Fauci, “That’s science, not anecdote,” said another of the sources.
The Dunning-Kruger is so strong in this administration that an economic advisor like Navarro thinks he can science better than Anthony Fauci! It’s even worse than that. Watch this four minute clip, if you dare:
First off, Navarro’s arrogance of ignorance is so extreme that he refers to his view as a “second opinion” to that of Dr. Fauci. I suppose that, literally, it is an “opinion,” but it’s an uninformed and ignorant one from someone who has no clue about clinical trial design. Next, contrary to Navarro’s claims, there are not “numerous studies” on these drugs and COVID-19. There just aren’t. I’ve documented the pathetic handful of studies that currently exist and why they don’t provide a strong signal of efficacy for hydroxychloroquine. Hilariously, Navarro then touts his qualifications as a social scientist with a PhD and he “understands how to read statistical studies, whether it’s in medicine and law.” (His PhD is in economics, which certainly doesn’t qualify him to interpret clinical trial and biomedical study data.) I would counter that, whatever Navarro might have learned about statistics during his studies, he appears to have forgotten if he thinks the studies supporting the use of hydroxychloroquine are strong.
When I first watched the video, I was happy to see John Berman pushing back, countering by saying that none of that qualifies Navarro to treat patients. Navarro does mention that nearly every COVID-19 patient in New York receives hydroxychloroquine. Sadly, that’s true. However, Berman cleverly pushed back some more by quoting doctors actually using the drug and pointing out that they told him that they don’t know if it works, contrasting their uncertainty to Navarro, “as a social scientist with no medical training” (a delightful twist of the knife), claiming that it definitely does. In response, Navarro basically backs off and retreated to JAQING off, and claiming that he never said that hydroxychloroquine definitely worked. As for me, I can attest that doctors I’ve communicated with using hydroxychloroquine to treat patients tell me that they are unimpressed and don’t think it works. Certainly, they have seen no dramatic effects.
As I’ve described before, the infatuation of the medical profession with hydroxychloroquine based on a dubious observation in Wuhan based on small numbers in January that patients with lupus don’t get COVID-19, anecdotes from China that led to an “expert opinion” that was widely adopted in numerous other countries, and a handful of negative or equivocal studies so flawed that they are uninformative has led to hydroxychloroquine becoming, in essence, standard of care for COVID-19. This has been an epic failure of science- and evidence-based medicine. This was true before the right wing noise machine latched on to these drugs.
Unfortunately, now that Trump propagandists and the usual bunch of scammers and grifters have glommed on to promoting these drugs as a “game changer” and the “beginning of the end of the pandemic,” the hope that evidence-based medicine will be allowed to do its work looks increasingly grim. Indeed, I predict that, even if doctors can now get enough patients to agree to possibly being randomized to a placebo in the face of all the media messaging that these drugs work and sufficiently powered clinical trials are negative, no one will believe them, and the same grifters will proclaim the results a conspiracy to keep evidence of a “cure” for COVID-19 from the people.