The harmful consequences of Trump’s obsession with hydroxychloroquine

I’ve noticed some misinformation – most of it unintentional – about Trump’s obsession with using hydroxychloroquine, an anti-malarial drug, to treat COVID-19. I wanted to clear things up, as much as possible.

The start

A Chinese and a French study found that hydroxychloroquine and azithromycin reduced the load of SARS-CoV-2, the virus responsible for COVID-19, in patients’ blood, although their clinical symptoms didn’t change much. The studies were not randomized and did not account for factors like previous health history.

The French study has garnered the most attention, even though experts have warned that the study is small and lacks sufficient rigor to be classed as evidence of a potential treatment. A medicinal chemist writes that “most of their patients only had mild symptoms. Furthermore, 85% of the patients didn’t even have a fever – one of the major telltale symptoms of the virus, thus suggesting that these patients likely would have naturally cleared the virus without any intervention.”

Trump took to Twitter after the study was published: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.”

Dr. Mehmet Oz then appeared on Fox News’ Hannity to promote the French study, conducted by Didier Raoult, and advocate for the use of hydroxychloroquine in the U.S. “This French doctor, [Didier] Raoult, a very famous infectious-disease specialist, had done some interesting work at a pilot study showing that he could get rid of the virus in six days in 100 percent of the patients he treated… I had the opportunity to interview Dr. Raoult. I was very impressed by him,” Oz told Hannity.

• Who is Raoult? “I am what the Americans call a” maverick,” he says. His work includes skepticism of climate change, of Darwin’s law and some vaccines. In one of his books, Raoult asserts unprotected sun exposure is good for you, unlimited alcohol consumption isn’t dangerous, and there is no such thing as antibiotic-resistant bacteria.

There have since been additional studies contradicting those promoted by Trump and the conservative media. Another study conducted in France, led by Jean-Michel Molina, found that after hydroxychloroquine-azithromycin treatment eight out of ten patients still tested positive for COVID-19. Additionally, one of these ten patients died, two were transferred to the ICU, and one had to be removed from the treatment due to serious complications.

Even the top infectious disease expert on the president’s task force, Dr. Fauci, has cast doubt on the potential of using the drug for COVID-19 treatment:

Asked about hydroxychloroquine at a briefing: “The information that you’re referring to specifically is anecdotal… It was not done in a controlled clinical trial, so you really can’t make any definitive statement about it.”

On Fox News: “So although there is some suggestion with the study that was just mentioned by Dr. Oz—granted that there is a suggestion that there is a benefit there—I think we’ve got to be careful that we don’t make that majestic leap to assume that this is a knockout drug.”

On Sunday, a reporter tried to ask Dr. Fauci about the drug and Trump stopped him from answering: “Do you know how many times he’s answered that question?” Trump cut in. “Maybe 15.” The reporter responded, “The question is for the doctor. … He’s your medical expert, correct?” Trump shook his finger at the reporter and said “You don’t have to ask the question,” and so Fauci didn’t answer it, and the news conference shuffled right along.

As a result of Trump’s enthusiasm, the FDA issued an emergency authorization allowing the use of hydroxychloroquine for treatment of COVID-19 on March 28. The agency still warns that the only people who should take the drug are those who cannot take part in a clinical trial.

The Trump-whisperers

Who is Trump listening to if not the experts? Why, the well known infectious disease experts Rudy Giuliani, Dr. Oz, Laura Ingraham, Larry Ellison, and Peter Navarro, of course!

Rudy Giuliani told the Washington Post that he’s spoken to Trump multiple times about hydroxychloroquine, claiming to have described the results of the French study to the president. In the past three weeks, Giuliani has tweeted about the drug 14 times. He apparently has gotten his wealth of knowledge from “a controversial Long Island family doctor with a following in the conservative media, as well as a former pharmacist who once pleaded guilty to conspiring to extort the actor Steven Seagal.”

One of the biggest promoters of hydroxychloroquine as a coronavirus treatment has been Dr. Oz. He has made eight appearances on Fox & Friends, seven on Hannity, two on Lou Dobbs, one on Morning with Maria, and one on Shannon Bream. Trump has taken notice and reportedly told aides he wanted to speak to Dr. Oz himself. It is unknown if that conversation occurred, but Oz has already spoken with top administration officials, including the administrator of the Centers for Medicare and Medicaid Services, Seema Verma.

• “He’s been dishonest and he has been dispensing misinformation to millions now for years,” physician and scientific researcher Henry I. Miller told The Daily Beast last month. “I wouldn’t trust any of his observations and don’t see how he would have responsible and valid views on coronavirus.”

Last Friday, Fox News host Laura Ingraham took two doctors who are regular guests on her show to the White House for a private meeting with Trump and FDA Commissioner Stephen Hahn. The two doctors were Ramin Oskoui, a Washington-based cardiologist, and Stephen Smith, a New Jersey-based infectious disease specialist. Smith presented Trump with his ideas for COVID-19 treatment and emphasized the benefits of hydroxychloroquine. According to the Washington Post, Trump “emerged from that meeting seemingly determined to advocate for hydroxychloroquine to be more widely used.

Over a week ago, Politico reported that an influential ally played a role in buttressing Trump’s faith in the drug: Oracle co-founder Larry Ellison, a top Trump campaign donor, pitched Trump on the drug and offered to build the government a database to track the use of chloroquine and hydroxychloroquine by doctors in the U.S. The White House has pulled multiple agencies into the effort to develop such a database, distracting from their work responding to the virus in ways that are proven to help.

“Everyone is getting ahead of their skis here,” said one senior Health and Human Services official involved in drug policy. “All this buzz is confusing the American public, it’s confusing doctors. There’s a ton of people involved in front-line response in the government … who are getting pulled into meetings to discuss this when the data doesn’t support it.”

A new report from Politico today reveals that career health officials have been warned not to publicly speak out and potentially contradict Trump on hydroxychloroquine. “Health officials have been told to prioritize [hydroxychloroquine] over other projects that scientists believe have more potential to fight the outbreak.”

Perhaps Trump’s most ardent supporter inside the task force is Economic Adviser Peter Navarro, who reportedly got into a heated argument with Dr. Fauci about the drug on Saturday. At a coronavirus task force meeting, Navarro asserted that he’s seen “clear therapeutic efficacy” of hydroxychloroquine in coronavirus patients. Fauci repeated what he’s said in public, that it is only anecdotal evidence at this point, which apparently “set Peter off.”

Navarro pointed to the pile of folders on the desk, which included printouts of studies on hydroxychloroquine from around the world. Navarro said to Fauci, “That’s science, not anecdote,” said another of the sources.

Navarro started raising his voice, and at one point accused Fauci of objecting to Trump’s travel restrictions, saying, “You were the one who early on objected to the travel restrictions with China,” saying that travel restrictions don’t work. (Navarro was one of the earliest to push the China travel ban.)

…Pence was trying to moderate the heated discussion. “It was pretty clear that everyone was just trying to get Peter to sit down and stop being so confrontational,” said one of the sources. Eventually, Kushner turned to Navarro and said, “Peter, take yes for an answer,” because most everyone agreed, by that time, it was important to surge the supply of the drug to hot zones.

Asked about the reported argument on Fox News, Navarro responded: “I think history will judge who’s right on this debate, but I’d bet on President Trump’s intuition on this one.”

What explains it?

So what explains Trump’s insistence that hydroxychloroquine will save the U.S. from the coronavirus? There are two main “schools of thought” here. One is that Trump’s personality faults make it attractive to support a miracle cure over the protests of experts. Other people posit that Trump will financially benefit from the sale of hydroxychloroquine.

Let’s deal with the financial aspect first, since that has been blowing up in the past 24 hours. It’s a difficult issue because there is some disagreement about the significance of the two following stories. So what I’ll do is provide just the facts, then put it in a larger context.

Cohen’s Novartis deal

In 2018, we learned that Trump’s former personal lawyer Michael Cohen signed a one-year contract with the multinational pharmaceutical company Novartis. Their subsidiary, Novartis Investments S.A.R.L., made up to $1.2 million in total payments to Cohen’s consulting firm between February 2017 and February 2018.

Stormy Daniels’ lawyer Michael Avenatti revealed the existence of the contract in the spring of 2018. Amid public scrutiny, Novartis explained that the contract with Cohen was for health-care policy consulting work that he proved “unable” to do.

Novartis said it believed Cohen “could advise the company as to how the Trump administration might approach certain U.S. health-care policy matters, including the Affordable Care Act.” But just a month after signing the deal, Novartis executives had their first meeting with Cohen, and afterward “determined that Michael Cohen and Essentials Consultants would be unable to provide the services that Novartis had anticipated.”

Trump’s stake in Sanofi

The other night, the New York Times reported that Trump has a “small personal financial interest” in the French pharmaceutical company Sanofi, which manufactures the brand-name version of hydroxychloroquine (Plaquenil). This story has garnered a great deal of attention even though there is not much information given. Here are the pertinent excerpts:

Mr. Trump himself has a small personal financial interest in Sanofi, the French drugmaker that makes Plaquenil, the brand-name version of hydroxychloroquine… As of last year, Mr. Trump reported that his three family trusts each had investments in a Dodge & Cox mutual fund, whose largest holding was in Sanofi.

That’s it.

ANALYSIS

This may not be popular to say, but it doesn’t appear that the Sanofi investment, alone, explains Trump’s incessant promotion of hydroxychloroquine. First of all, Trump doesn’t directly own Sanofi stock – he holds it in three family trusts through an investment in the mutual fund Dodge & Cox’s international stock fund. Going by Trump’s 2019 financial disclosures, Trump’s family trusts have each invested between $1 to $15,000 in Dodge & Cox’s fund. Financial Times reporter Kadhim Shubber wrote this means the president’s stake in Sanofi is likely worth about $30- $450 for each family trust, or about $1,350 maximum total.

That Sanofi investment would therefore constitute between 0.000003 and 0.00005 percent of Trump’s net worth. If you were worth $100,000, it would be like worrying about the nickel in your pocket. (WaPo)

Other shares in the fund include some in AstraZeneca, Novartis, Bayer, GlaxoSmithKline, as well as online retail, electronics, and banking companies.

Furthermore, (1) hydroxychloroquine is a very cheap generic made by a bunch of different pharmaceutical companies. (2) Sanofi no longer sells or distributes Plaquenil in the United States, although it does sell it internationally. (3) The largest suppliers of the drug in the U.S. are in India. After Trump’s endorsement, global stockpiling of hydroxychloroquine caused India to ban exports of all forms of the drug. Yesterday, Trump threatened retaliation and India agreed to drop the ban.

as Ami Fadia of SVB Leerink, a health care investment company, told Barron’s, any additional hydroxychloroquine sales aren’t likely to greatly impact drug companies’ bottom lines because, even if they are able to quickly ramp up production, it is a relatively cheap drug in its generic form. Fadia said it can cost as little as 32 cents per pill.

The argument that Novartis’ contract with Michael Cohen years ago has affected Trump’s decisions today are even weaker.

NOTE: This is not to say that Trump doesn’t have a conflict of interest here. Trump’s decision not to sell off his assets or put them into a blind trust casts any action he takes in doubt – the question will always loom: Does Trump financially benefit from this? And there has been plenty of times the answer is a resounding “yes!” We must be careful not to sound a false alarm, though.

Alternative explanation: Trump is Trump

Many argue that we don’t have to look to financial interests to explain Trump’s obsession with using hydroxychloroquine to treat COVID-19. Trump (1) thinks very highly of himself and his “gut feelings,” and (2) wants a magic cure to get his “great” economy back.

Bolstered by his friends and allies, Trump has supreme confidence in his ability to know the most about everything. We have seen it numerous times in the past, when Trump claimed to be an expert on everything from campaign finance, to ISIS, to renewable energy and Sen. Cory Booker.

Trump compensates for his own insecurity by working to convince himself and everyone else that the experts don’t know what they’re talking about, and he knows more than them about everything. As he said in an appearance at the Centers for Disease Control and Prevention, “Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability.” The scientists standing with him neither burst out in laughter nor began weeping uncontrollably, a tribute to their self-control. (WaPo)

Finally, Trump is also desperate. The fact of the matter is there is no miracle pill to stop the coronavirus and open up the country in as little as four weeks, as Larry Kudlow hopes.

“We had the greatest economy in the history of the world, we had the most people working in the history of our country, almost 160 million people, far more than ever before. And then one day, our professionals correctly came to us and they said, ‘sorry, sir, we have to close down our country,’” Trump lamented Monday at a White House news conference.

Trump wasted months before preparing for the virus. As much as he’d like to avoid blame, the truth is that his administration failed to effectively respond to a global pandemic that has killed over 12,000 Americans so far. From Trump’s perspective, as he said about the drug, “what do you have to lose?”

If Trump can claim that he personally defeated covid-19, then he might just win. If hydroxychloroquine somehow turns out to be an effective treatment, he can point to all the time he spent promoting it while others were skeptical and say, “I did it, America. I saved all your lives, because I’m a genius and the so-called experts are idiots.” (WaPo)

The dangers

As we’ve seen, Trump is diverting attention and resources from more promising solutions, like a vaccine, to focus on his miracle drug. But that’s not the only danger of his obsession with hydroxychloroquine:

1. ProPublica: Trump’s push to use hydroxychloroquine to treat COVID-19 has triggered a run on the drug. Healthy people are stocking up just in case they come down with the disease. That has left lupus patients like Valdez and those with rheumatoid arthritis suddenly confronting a lack of medication that safeguards them, and not only from the effects of those conditions.
2. NYT: Doctors are hoarding medications touted as possible coronavirus treatments by writing prescriptions for themselves and family members, according to pharmacy boards in states across the country.
3. Trump has said “what do you have to lose” while claiming that hydroxychloroquine is completely safe, but this is not true. About 10% of the population is susceptible to serious and potentially lethal side effects: Poison.org warns that the anti-malaria drug can cause a dangerous heart rhythm. When seriously ill COVID-19 patients are given hydroxychloroquine, they are “connected to continuous heart monitors and also get serial electrocardiograms (electrical monitoring of the heart) to look for abnormal heart rhythms before they become life-threatening.”
4. Furthermore, Poison.org warns that “chloroquine and hydroxychloroquine have major drug interactions with other medicines that can put a person at an even greater risk of an abnormal heart rhythm.” One of these drugs is actually azithromycin, which the French study used in combination with hydroxychloroquine.
5. People may take matters into their own hands. You may remember that two weeks ago, CNN reported: “A Phoenix-area man is dead and his wife is under critical care after the two took chloroquine phosphate in an apparent attempt to self-medicate for the novel coronavirus.” Nigeria reported that three people in their country overdosed on chloroquine after Trump’s endorsement.

Appendix: The rightwing misinformation ring

Dr. Fauci’s refusal to support Trump’s promotion of hydroxychloroquine has put a target on his back. Some in the right-wing are pushing the idea that Fauci is an agent of the “deep state” sent to derail Trump’s presidency.

Media Matters: “the president has been exactly right about those two drugs – Hydroxychloroquine – it’s just amazing… And the president was right and frankly Fauci was wrong. Because he said the president is speaking as a layman. No, he’s speaking as the President of the United States whose responsibility is for the lives and safety of millions of Americans. Whose actions by this president, you know, depend.”

Buzzfeed News: QAnon-supporting radio host Bill Mitchell has been the biggest promoter of the latest theory. For weeks, Mitchell has been spinning a conspiracy theory that Fauci is a “Democrat plant” and nicknamed him “Dr. #FearPorn.” Mitchell’s first tweets about Fauci date back to March 3, when Fauci first suggested the closure of schools and businesses… On the evening of March 20, Mitchell tweeted about Fauci 36 times in 30 minutes. Mitchell was enraged at Fauci going on CNN and publicly disagreeing with Trump’s suggestion that the CDC should allow the use of the anti-malaria drug chloroquine.

As a result of the conspiracy-frenzy, Fauci has reportedly faced threats to his personal safety and was forced to increase his security.

Some other examples of the right-wing’s involvement:

• Variety: Twitter, stepping up its enforcement of misleading and harmful coronavirus-related claims, required Fox News host Laura Ingraham to delete a tweet from 10 days ago that misrepresented details of an unproven treatment for coronavirus. In the now-deleted tweet from March 20, Ingraham, host of the cable network’s “The Ingraham Angle,” wrote, “Lenox Hill [Hospital] in New York among many hospitals already using Hydroxychloroquine with very promising results. One patient was described as ‘Lazarus’ who was seriously ill from Covid-19, already released.”
• Business Insider: Twitter removed a message by Rudy Giuliani, President Donald Trump’s personal attorney, for spreading misinformation about the coronavirus… In the tweet on Friday, Giuliani quoted conservative youth activist Charlie Kirk, who claimed that an unproven anti-malaria drug, hydroxychloroquine “in at least three international tests was found 100% effective in treating the coronavirus.”
• Wired: Google Bans Infowars Android App Over Coronavirus Claims… [in a video in the app] Jones disputed the need for social distancing, shelter in place, and quarantine efforts meant to slow the spread of the novel coronavirus… Earlier this month, New York attorney general Letitia James sent him a cease and desist notice for saying in videos and on the Infowars website that his DNA Force Plus supplements, Superblue toothpaste, and SilverSol gargle could protect against or treat the novel Coronavirus.
• Daily Beast: Right-wing figures eager to downplay the coronavirus pandemic’s death toll have hit on a new idea: filming quiet hospital parking lots. Over the weekend, a growing number of pro-Trump personalities decided that the way to prove that the media was overhyping the pandemic was to film places where cars and ambulances show up to drop patients off. If the entrances were quiet and the parking lots mostly empty, they claimed, that was proof that the coronavirus’ effects had been overstated. (alternative source: NBC News)