The Hydroxychloroquine Flap

Hydroxychloroquine is a prescription drug used to tread lupus, rheumatoid arthritis, and malaria. Like a lot of presciption drugs it can cause nasty side effect, including possibly fatal heart damage and permanent vision loss. It is known to interact badly with some other drugs, such as insulin and other diabetes drugs; drugs that treat common heart problems; and antiseizure and immunosuppresant drugs. So it’s not something you should take without close medical supervision, and you should take it only if you really need it.

Hydroxychloroquine also is thought to have anti-viral properties, and there have been studies for using it to treat viral diseases going back 40 years, according to the Lancet. However,

Hydroxychloroquine has shown activity in vitro against many viruses, including influenza and coronaviruses, but that has largely failed to translate into success in either animals or humans. In 2005, the drug showed in vitro activity against SARS-CoV, which is closely related to the current pandemic virus, but it failed to decrease viral load in mice, and clinical interest drifted away, says Christopher Tignanelli, a surgeon at the University of Minnesota in Minneapolis, who is involved in clinical trials of COVID-19 treatments.

“There is not a huge amount of pre-clinical data for this drug,” says Tignanelli. “It’s mostly test-tube and anecdote.”

In other words, while it’s not impossible that hydroxychloroquine would be useful to treat our current coronavirus, that’s a long shot. Claims about patients it helped might just be a placebo effect. And given the drug’s risks, it’s not something to hand out to people indiscriminately in case it might help.

So when Donald Trump, who is hyping hydroxychloroquine, says “What do you have to lose? Take it,” the answer to his question is that you could lose your eyesight or your life. You could also lose your hair and develop ringing in the ears, nasty rashes, and suicidal thoughts.

But the degree to which elements in the Trump administration are pushing hydroxychloroquine as the magic bullet that will get us out of this pandemic mess suggests either desperation or avarice, or both. Suddenly there are shortages, which also suggests hoarding and a lot of the pills being diverted into a black market. It’s also the case that much of the hydroxychloroquine sold in the U.S. comes from India, which has stopped exports to the U.S.

A website called Sludge that may or may not be reliable claims that the Trump administration is being aggressivly lobbied to promote hydroxychloroquine by conservative groups with ties to the pharmaceutical industry. So there’s that.

CNN reported on a tense encounter among White House advisers over the weekend:

While discussing the latest on hydroxychloroquine this weekend, an exasperated Navarro lashed out at Dr. Anthony Fauci, one of the advisers who has urged caution about the drug, a person familiar with the meeting told CNN.

Navarro had brought a stack of paperwork with him into the Situation Room on the drug, arguing it was proof that it could work to treat coronavirus, which Fauci, the nation’s top infectious disease expert, disagreed with because it was not data.

“What are you talking about?” Fauci asked — a question that set Navarro off. He became indignant, and at one point, accused Fauci of opposing Trump’s travel restrictions on China, which confused many in the room, given Fauci was one of the initial few to agree with Trump on the move, the source said.

Navarro, allegedly an economist, was mostly known for advising Trump on trade policy before the pandemic turned him into a medical expert. Be afraid. But Trump himself is the biggest salesman for the drug. Back to CNN:

Without citing evidence, Trump said at Sunday’s briefing that hydroxychloroquine is a “great” and “powerful” anti-malaria drug “and there are signs that it works on this, some very strong signs.”

For people without heart problems, Trump recommended combining hydroxychloroquine with azithromycin, a common antibiotic. He said azithromycin “will kill certain things that you don’t want living within your body.”

Yet there is little reliable evidence that the drugs — either alone or in combination — are effective at treating the novel coronavirus.

Still, Trump said: “What do you have to lose? What do you have to lose?”

For doctors, nurses and first responders, Trump suggested the drugs could be taken as a preventative. “They say taking it before the fact is good, but what do you have to lose?”

Experts do not suggest taking hydroxychloroquine as a preventive for Covid-19 because there is no evidence yet to suggest it protects against contracting the virus.

“They say take it,” said Trump, without citing any experts or sources. “I’m not looking at it one way or the other, but we want to get out of this. If it does work, it would be a shame if we didn’t do it early. But we have some very good signs.”

Trump also said the US Food and Drug Administration gave hydroxychloroquine “rapid approval,” but in fact, the FDA has not approved it for the treatment of Covid-19.

Talk like this is going to ramp up black market sales, big time, and probably kill a lot of people.

Peter Wade writes in Rolling Stone,

What exactly Trump’s motives are to get behind the unproven coronavirus remedies remains to be seen. But between this weekend’s reported argument coming out of the White House, sending out Navarro to undermine Fauci’s advice on the topic is disturbing. Adding to that, Trump himself did not allow Dr. Fauci to comment on hydroxychloroquine when reporters asked about the administration’s insistence to promote the drug during a recent briefing and new reporting by the Washington Post tells of Rudy Giuliani’s involvement in the chloroquines game while attempting to “cast himself in a new role: as personal science adviser.” The whiff of a new grift is strong.

It might be that Trump just wants there to be an easy cure for the coronavirus in order to get the pandemic out of the way, and the stock market back up, before the November election. He seems susceptible to magical thinking, in particular the notion that if he says something often enough and forcefully enough reality will bend to his will. But it’s also the case that somebody must smell money to be made.

Charles Pierce:

The president’s position is that he wants this to be true, and if he says it over and over and enough people believe him, it might as well be true. This strategy is not science, and goes against all the achievements of the human race that brought us out of the Dark Ages, but it’s what got him to the White House.

We elected a snake-oil salesman as President of the United States, and by God, he’s going to peddle some snake oil. How long, really, until we find out someone in Trump’s orbit stands to benefit financially from boosted sales of hydroxychloroquine? The most innocent explanation here is that Trump is merely a desperate and scared conman who is in way over his head. The least innocent is that he’s grifting on a global pandemic after completely botching the American response. …

… But now the whole right-wing grift-o-rama machine is oiled up and humming. The lackeys on State TV are peddling it in every segment they can, because he’s peddling it and their job is to peddle him.

So a lot of people are going to be taking lordy-knows-what sold to them as hydroxychloroquine, and maybe it’ll just be sugar pills that don’t do any harm, but it could give them a false sense of security leading to reckless behavior. Or, worse, it might really be hydroxychloroquine, and they could be hit with the dangerous side effects. If doctors want to try it as a last-ditch therapy on the sickest coronavirus patients that’s one thing, but you know it’s not going to stop with that.

In other news — Josh Marshall has been noting instances of our federal government seizing shipments of medical supplies heading to states or hospitals, and sometimes to other countries. See, for example, What’s Up with the Feds Seizing PPE Shipments to States and Hospitals?

Let’s talk about these seizures of PPE goods by federal authorities. There are a number of instances of this and as I noted in the post below a number of reasons why it might be happening. There are numerous cases where orders placed by states or hospitals have been canceled after they have been outbid by federal authorities or federal authorities have ordered vendors to sell to the federal government. According to Kaiser Health News, those compelled sales appear to be pursuant to an executive order President Trump signed on March 18th under authorities granted by the Defense Production Act.

But what I’m more interested in are reports of federal authorities confiscating physical shipments en route to states, local governments or regional hospital systems. The most publicized case of this came at some point in March when, according to Massachusetts Gov. Charlie Baker (R), a shipment of 3 million masks ordered through BJ’s Wholesale was seized by federal authorities in the Port of New York. Baker did not say which agency confiscated the goods or under what authority. That incident was what led to the widely reported and successful effort to fly goods in from China using the New England Patriots jet. …

… It’s not entirely clear from the report. But this does not sound like the federal government outbid the county or forced it to sell but rather that the physical shipment was interdicted and seized by federal authorities.

See also Barbados Claims US Seized Ventilators En Route to Country. Basically, it sounds like some part of the U.S. government is just flat-out seizing materials that had been lawfully purchased and were en route to the purchaser. WTF? Where are these supplies going? Who has them? Where are they going? Who is making money from this?