Hydroxychloroquine and the Politics of the Corona Crisis
“Just trust yourself, then you will know how to live.” – Johann Wolfgang von Goethe
In his earliest speeches about COVID-19, Trump downplayed the threat and up-played the hope that a vaccine or therapeutic drug would soon be available. On March 19, he mentioned one such drug specifically: hydroxychloroquine (HCQ). It’s a medication that has been used to treat malaria, rheumatoid arthritis, and lupus for nearly 70 years.
In his usual bombastic style, Trump talked about the drug as a miracle cure. That struck left-leaning politicians and media (LLP&M) as odd. “Why single out this one drug?” you could almost hear them thinking. “We know he’s an amoral narcissist who knows nothing about science or medicine. Something nefarious is going on.”
They launched an investigation and discovered that one of the stocks in the Trump family portfolio was none other than the company that makes hydroxychloroquine.
“Trump Touting Drug for Personal Gain!” the headlines read. But before the ink dried, pro-Trump politicians and media were doing their own research. They found that the shares held by the family had a value of just a few hundred dollars. The charge that Trump was pumping the stock was absurd.
With that salvo missing the mark so widely, the LLP&M fired a more targeted shot: “Trump is not a doctor!” they pointed out. “He’s an arrogant, ignorant businessman. How dare he promote an unproven medication!”
How dare he, indeed?
There could be only one answer. The RLP&M had to find evidence that HCQ is effective – i.e., that Trump was right.
And thus began a soap opera of misinformation that has continued non-stop.
Let’s look at some of the highlights:
On March 19, Trump announced that he was going to “fast-track” FDA approval of HCQ. He said that the drug had shown promise and that “it has been around for a long time, so… it’s not going to kill anybody.”
Two days later, he tweeted about HCQ again. This time, he cited a study conducted by France’s Aix-Marseilles University.
The study, published in the International Journal of Antimicrobial Agents, looked at 42 patients that had tested positive for COVID-19. Initially, 26 took daily doses of 600 milligrams of HCQ, six took 600 milligrams of HCQ plus azithromycin, and the rest acted as a control group, getting a placebo only. Of the 26, one died and five others dropped out. So the completed study consisted of 20 on HCQ only, 6 on HCQ plus azithromycin, and 10 in the control group.
The results were encouraging. All of the patients treated with HCQ and azithromycin were free of the virus after five days. The 20 that took HCQ only recovered, but more slowly. The control group experienced more symptoms and even slower recoveries.
The researchers concluded: “Despite its small sample size, our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction [or] disappearance in COVID-19 patients and its effect is reinforced by azithromycin.”
Their conclusion was challenged almost immediately for being too small and too quick. One critic quoted by the LLP&M, Elisabeth Bik, questioned the peer review process, noting that it took only a few days, rather than months, which is typical.
On March 24, the major media published a story about a man in Arizona that died after ingesting a non-medication form of chloroquine phosphate in an attempt to avoid contracting COVID-19. Ignoring the fact that chloroquine phosphate is not HCQ and was never approved by the FDA, as HCQ was, the LLP&M jumped all over it, accusing Trump of promoting a deadly poison.
Nevertheless, on March 28, the FDA issued an emergency authorization allowing hospitals to treat COVID-19 patients with HCQ.
On April 10, a group of physicians published a statement expressing concern that using HCQ “might do more harm than good.” Three days later, a small study in Brazil noted that some patients taking high doses of HCQ had developed an irregular heartbeat. And then, on April 22, a retrospective study of 368 patients conducted by the Veterans Health Administration and published in the New England Journal of Medicine concluded that HCQ “showed no benefit for patients hospitalized with COVID-19.”
Again, this was widely reported by the LLP&M.
On May 11, HCQ and azithromycin were back in the news. JAMA (the Journal of the American Medical Association) published a retrospective cohort study of 1438 patients hospitalized in metropolitan New York from March 15 to March 28. The study measured mortality rates among four groups: one that was treated with HCQ only, another that was treated with azithromycin only, a third that was treated with both, and a control group that received no drug therapies at all.
The study found a lower mortality rate with the three groups that were treated with one or both of the drugs, but noted that the differences were statistically insignificant.
It was enough for the FDA to reverse its emergency use authorization and declare: “In light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of HCQ no longer outweigh the known and potential risks.”
This was widely reported in the LL media as proof that HCQ was not effective. It also gave Joe Biden the chance to put his presidential opponent in an ethical checkmate. Trump, he said, is pushing “dangerous drugs. Our country is now stuck with a massive stockpile of HCQ, a drug Trump repeatedly hailed.”
Well, the RLP&M wasn’t going to turn on their king so easily. They had their scientists look into the JAMA study and noted that it was neither peer reviewed nor scientifically sound. “They didn’t adjust results for variables such as disease severity, drug dosage, or when the patient started treatment,” Allysia Finley noted in a recent WSJ opinion piece.
In late May, the Lancet medical journal published a large-scale international study claiming that hospitalized COVID-19 patients treated with HCQ were 30% more likely to die than those not treated with the drug.
Again, this made headlines. But on June 4, a review of the study by 120 doctors and scientists said that it had “significant flaws in the data and methodology.” They pointed out that, in their conclusion, the researchers did not disclose that the patients had been given HCQ, on average, four days after symptoms had appeared. (Which, by the way, should not have been surprising since the protocol for HCQ called for using it before or immediately after symptoms appeared.) “It stands to reason,” the reviewers said, “that taking HCQ in the fourth day would be unlikely to work very well.” They also pointed out that the conclusion neglected to note that the same data showed that people that took HCQ within two days of exposure were 38% less likely to develop symptoms.
Shortly thereafter, the Lancet retracted its publication of the study, stating that not only was the conclusion questionable, but the researchers had refused to provide their raw data for inspection.
On June 5, the day after the Lancet’s publication of the study had been challenged, the University of Oxford announced that a midpoint review of their HCQ trial had found no clinical benefit. “This report should change medical practice worldwide,” the leader of the review proudly said at a press conference.
On July 15, Oxford released more information on the trial. It turned out that the patients had been treated with HCQ nine days after symptoms appeared – again, much later than the suggested protocol.
On June 30, the Journal of General Internal Medicine published a study which found that patients treated with HCQ at New York’s Mount Sinai Health System hospitals were “47% less likely to die after adjusting for confounding variables such as underlying health conditions and disease severity.” The patients had been treated, on average, one day after the onset of symptoms, and with a dosage that was three times smaller than the dosage used in the Oxford trial.
Another report, published July 1 in the International Journal of Infectious Diseases, found that patients treated with HCQ at Henry Ford Health System hospitals in Detroit were “50% to 66% less likely to die after adjusting for confounding variables including other treatments.”
And finally, an FDA safety review published July 1 reported 5 adverse side effects from HCQ among the tens of millions of doses that were distributed to hospitals as a result of their emergency use authorization.” In other words, HCQ wasn’t harmful to the vast majority of the patients that were treated with it.
So as of right now, the RLP&M are winning the chess game. The latest data suggests that HCQ may be an effective treatment in reducing symptoms if given early and according to FDA guidelines.
But the game isn’t over. In fact, the pace has accelerated. By the time you read this, there will almost surely be a report in the LLP&M on some new study that concludes that, no, HCQ is not effective and that Trump was and is a dangerous fool.
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