In early April, before there was much data on possible COVID-19 treatments, President Trump promoted one that seemed to have anecdotal backing. Hydroxychloroquine was suggested as a possible treatment very early in the pandemic and received some weak support through a very flawed French study. That was enough for Trump to suggest people take it, his rhetorical “What have you got to lose?” question that blows past the drug’s known and potentially dangerous side effects.
In the aftermath, however, Trump kept quiet on the subject, and evidence mounted that chloroquine did little while preserving the problematic side effects. But it came back into the limelight on Monday when Trump announced he had used it, possibly in response to several cases among White House staff. This, of course, led to questions about why he did so in light of the research that has emerged in the intervening weeks. Trump’s response was to label an investigation by government investigators a “Trump enemy statement.”
The chloroquine saga
Chloroquine and its derivatives, such as hydroxychloroquine, were first developed as antimalarial drugs. But they have different effects on the body and have found application through their role as immune suppressants in the treatment of autoimmune diseases such as lupus. In cultured cells, they exhibit relatively general antiviral activity, including the suppression of SARS-CoV-1. This led a number of teams to try chloroquine against SARS-CoV-2 early in the pandemic. In particular, a French team released a concept study that seemed to show promising results.
Other researchers pointed to some serious flaws in the draft study, but by then a landslide had begun that was difficult to stop. Numerous other groups began trials of the drug, and the FDA approved its emergency use for COVID-19. There was a run on the drug that made it difficult for people with autoimmune diseases to get the prescriptions they needed — and that was before Trump’s “What have you got to lose?” Promotion.
All of this seemed to ignore the drug’s very well-known side effects, including slowing a key interval in the heart’s rhythm. This can cause fatal cardiac arrhythmias in vulnerable patients.
However, additional results have come in since March, most showing that chloroquine has a limited impact on COVID-19 and that the known side effects are still present and sometimes fatal. Prominent among these was a study by the US Veterans Administration, which was quickly followed by the FDA issuing a safety notice stating that the drugs should only be used in hospitalized patients or through clinical trials.
All of these studies were limited, with small patient populations and/or without randomization and placebo arms. But over time, the trials got bigger; a recent one followed the results of more than 1,400 patients. And other researchers started doing meta-analyses, combining the data from multiple smaller studies. One of these combined records of more than 4,000 patients and reiterated the growing consensus: no impact on COVID-19 and “significantly higher incidence of side effects with hydroxychloroquine”.
Bring on the politics
Under normal circumstances, this would be when attention turned away from chloroquine derivatives and turned to drugs that could actually work. Trump’s silence on the subject would no doubt have made this possible, though the drug had developed a fanatical following who seemed indifferent to the mounting evidence. But things have changed, perhaps as a result of some recent cases that have surfaced in the testing of White House personnel. Trump says he recently asked his doctor to start him on the hydroxychloroquine and made that information public this week, and he went right back to promoting the drug.
In doing so, Trump basically ignores both evolving and established science. In the established category, he is now essentially saying that the potentially fatal cardiac side effects do not exist. In a pair of press Q&As held Tuesday, Trump claimed, “It doesn’t hurt me,” and “it doesn’t hurt people,” and “you don’t get sick or die” if you take it. Those statements contradict decades of data and experience.
But Trump also prefers anecdotes to the growing research consensus. “I think it’s okay,” he said in response to a question. “I’ve heard a lot of good stories.” Later he suggested those stories goods the equivalent of proof, saying, “This is my proof: I get a lot of positive calls about it.” Elsewhere in the same session, however, he admitted, “It seems to have an impact, and maybe it has; maybe not.”
This could easily be dismissed as ignorance of the state of the evidence, but that doesn’t really seem to be true, as Trump made it clear that he was very well aware of the Veterans Administration’s study providing some of the first evidence. that hydroxychloroquine is ineffective. But he has an explanation for why that evidence exists: It was a flawed study by a bunch of Trump haters.
Trump falsely states that there is only one single report suggesting that chloroquine is ineffective and potentially harmful, saying, “And if you look at that one survey, the only bad poll, they gave it to people who were really bad at it.” were very old, almost dead.” Elsewhere, he called it a “fake” report and an “unscientific report,” again emphasizing that the drug was given to people who were very ill. That’s a limitation of the study, but again, that’s not the only study showing that chloroquine is ineffective.
Not content with compromising the quality of the study, Trump attacked the researchers himself: “The only negative I’ve heard was the study where they gave it, it was the [Veterans Administration]† With, you know, people who aren’t huge Trump fans gave it.” He later called the study “a statement from a ‘Trump enemy.'”
Personal beliefs versus science
The number of problems in just these brief statements is extraordinary. Trump is promoting misinformation about a drug with potentially fatal side effects. He ignores a wealth of relevant studies. And he suggests that the only reason a study turned up results he didn’t like is that the researchers behind it decided to attack him.
This isn’t the first time those in power have misrepresented the state of science; climate change has been repeatedly affected by this problem. And politicians have sometimes suggested that climate scientists’ conclusions were driven by political or financial considerations rather than data. But the charge that scientists draw conclusions from personal hostility to a single politician seems like a first, and it’s a potentially dangerous one.
How dangerous? As mentioned above, current FDA policy is that chloroquine’s side effects are dangerous enough that it should not be used outside of hospitalization or a clinical trial. But when asked how Trump’s use of the drug appears to go against those guidelines, the FDA commissioner seemed to distance himself from his agency’s own policies.