Biologist: At best, hydroxychloroquine will have only a mild effect so knock it off with this nonsense


Given how rhetorically invested Trump and Fox News are in hydroxychloroquine as a possible miracle drug, this is like going on the Golf Channel to declare that golf sucks.

William Haseltine is known for his work on HIV and in developing therapeutic drugs based on viral genomes. I’m surprised at how bearish he is about the likely efficacy of HCQ given the global uncertainty about it and the likelihood that we’ll have data soon from New York that might contradict him. For instance, Andrew Cuomo said at his press conference this morning that there’s been encouraging anecdotal evidence about the drug’s benefits. A Democratic state representative from Michigan said she experienced a “Lazarus effect” when she tried hydroxychloroquine after experiencing symptoms in late March. The American Thoracic Society in New York also endorsed hydroxychloroquine for coronavirus patients today — but only in severe cases and only if the patient is conscious and can be informed of potential side effects. As a doctor at the Mayo Clinic said to the New York Daily News, it’s one thing to risk severe side effects in one percent of patients when you’re only giving the drug out to a few hundred or few thousand people who are already critically ill and have little to lose. It’s another thing to risk severe side effects in one percent if you’re giving it out to a million otherwise healthy people prophylactically. That’s the risk we run when Trump endorses it on a big public stage. It’s not the very sick who’ll watch him and go hunting for a prescription. It’s the general public.

Haseltine will lose some credibility if HCQ turns out to be effective. Trump will lose some credibility if turns out not to be. That’s the political risk in touting the drug, on top of the shortages and potential misuse by people who’ll end up taking it as preventive medicine. Not that the president has a large reservoir of credibility left outside his base, but it’d be good for him to hold on to what he has during an epidemic in which the public will be asked to rely repeatedly on government advice for the next year and a half:

This brazen dispensation of medical advice from the president is dangerous in ways beyond the potential harm of the drug itself. A time of strict directives for personal behavior and hygiene requires tremendous trust in those giving the directives—and understanding the reality that this is a disease without a miracle cure. But instead of inspiring trust, Trump has pivoted from downplaying the number of cases in the United States to the extremely effective trick of quack medical providers: hyping an unproven treatment that entices desperate people with false confidence and confusing messaging…

Based on the limited evidence so far, giving hydroxychloroquine to people could very well be—as with most drugs that modulate the immune system—of some benefit in some circumstances. Some people will be made sicker by it, depending on underlying physiology, other medications they’re taking, timing, and dosing. Identifying who stands to benefit and why requires data, and several randomized controlled studies of hydroxychloroquine are under way.

Whether he realizes it or not, he’s placed a big political wager on HCQ. He’s spent the past several weeks touting it; Anthony Fauci has spent the past several weeks insisting that there’s no hard evidence yet that it works. If the drug turns out to be a bust, who’s the public more likely to trust in the coming debate over whether it’s safe to go back to work? The Trump side that’s urging people not to trust the egghead doctors who don’t care about working people or the Fauci side that’s urging people to stay at home a little while longer as testing continues to ramp up?

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The focus on hydroxychloroquine would be easier to take seriously if the drug hadn’t immediately become a sort of MAGA totem among Trump cronies. If Peter Navarro, for instance, were eager to find a therapy that seems very likely to work, he’d put HCQ on the backburner while doctors are trying it out in New York and focus on antibody therapies that are in development. Obsessing about the drug to the point of throwing a fit in a White House meeting about it smells more like an act of TrumpWorld virtue-signaling — all-in on the president’s favored miracle drug — than a serious attempt at prioritization. Same goes for this poor bastard, who was a highly relevant figure in American politics again for the past year and then saw his notoriety go up in smoke thanks to the COVID-19 outbreak. Now here he is grasping for a way back towards relevance and finding it in hydroxychloroquine:

In one-on-one phone calls with Trump, Giuliani said, he has been touting the use of an anti-malarial drug combination that has shown some early promise in treating covid-19, the disease the novel coronavirus causes, but whose effectiveness has not yet been proved…

“​He’s been out of the news and out of the limelight since the end of the impeachment drama,” said Andrew Kirtzman, a Giuliani biographer who is writing his second book about the former New York mayor. “What you’re seeing is an effort to regain relevance.”…

Giuliani said that he has not discussed the treatment with Fauci, but that Trump agrees with him. “I’m sure he thinks I am an ignoramus,” he said of Fauci.

An ignoramus? Why would Fauci think that?

Rudy went on to complain to WaPo that academics like Fauci don’t live “in the real world” because they’re busy grumbling about clinical trials in the middle of an epidemic, when people are dying by the thousands. We need to be willing to take a little risk with hydroxychloroquine in the name of saving lives, Giuliani said — as if thousands of patients in New York hospitals aren’t receiving the drug right now as part of an observational trial. Comments like that are why I think, for people like Rudy, the chatter about HCQ has a political undertone. It’s not about what’s happening in reality. It’s about backing Trump up and finding a path back to TV cameras by telling people something they desperately want to hear.

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